CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France; Inserm, CIC 501, Clermont-Ferrand, France; Inserm, U1107 "Neuro-Dol," Clermont-Ferrand, France.
Univ Clermont1, Clermont-Ferrand, France; CHU Clermont-Ferrand, Pôle Santé Publique, Clermont-Ferrand, France; CNRS, ISIT, UMR6284, Clermont-Ferrand, France.
J Pain. 2014 Jan;15(1):24.e1-24.e20. doi: 10.1016/j.jpain.2013.08.014. Epub 2013 Oct 25.
To investigate the role of peripheral neuropathy in the development of neuropathic postsurgical persistent pain (N-PSPP) after surgery, this French multicentric prospective cohort study recruited 3,112 patients prior to elective cesarean, inguinal herniorrhaphy (open mesh/laparoscopic), breast cancer surgery, cholecystectomy, saphenectomy, sternotomy, thoracotomy, or knee arthroscopy. Besides perioperative data collection, postoperative postal questionnaires built to assess the existence, intensity, and neuropathic features (with the Douleur Neuropathique 4 Questions [DN4]) of pain at the site of surgery were sent at the third and sixth months after surgery. In the 2,397 patients who completed follow-up, the cumulative risk of N-PSPP within the 6 months ranged from 3.2% (laparoscopic herniorrhaphy) to 37.1% (breast cancer surgery). Pain intensity was greater if DN4 was positive and decreased with time since surgery; it depended on the type of surgery. In pain-reporting patients, the response to the DN4 changed from time to time in about 1:4 of the cases. Older age and a low anxiety score were independent protective factors of N-PSPP, whereas a recent negative event, a low preoperative quality of life, and previous history of peripheral neuropathy were risk factors. The type of anesthesia had no influence on the occurrence of N-PSPP.
ClinicalTrials.gov, NCT00812734.
This prospective observational study provides the incidence rate of N-PSPP occurring within the 6 months after 9 types of elective surgical procedures. It highlights the possible consequences of nerve aggression during some common surgeries. Finally, some preoperative predispositions to the development of N-PSPP have been identified.
为了探究外周神经病变在术后神经病理性持续性疼痛（N-PSPP）发展中的作用，本项法国多中心前瞻性队列研究在择期剖宫产、腹股沟疝修补术（开放式网片/腹腔镜）、乳腺癌手术、胆囊切除术、隐静脉切除术、胸骨切开术、开胸术或膝关节镜检查前，招募了 3112 名患者。除围手术期数据收集外，术后还通过邮寄问卷评估手术部位疼痛的存在、强度和神经病理性特征（采用 4 项神经性疼痛问卷[DN4]），分别在术后第 3 个月和第 6 个月进行评估。在完成随访的 2397 名患者中，6 个月内 N-PSPP 的累积风险范围为 3.2%（腹腔镜疝修补术）至 37.1%（乳腺癌手术）。DN4 阳性时疼痛强度更大，且随手术时间的推移而降低；其还取决于手术类型。在有疼痛报告的患者中，DN4 的应答情况在大约 1:4 的病例中随时间而变化。年龄较大和焦虑评分较低是 N-PSPP 的独立保护因素，而近期的负面事件、术前生活质量较低和既往外周神经病变史是危险因素。麻醉类型对 N-PSPP 的发生无影响。
ClinicalTrials.gov，NCT00812734。
本前瞻性观察研究提供了 9 种择期手术术后 6 个月内 N-PSPP 的发生率。它强调了某些常见手术中神经损伤的可能后果。最后，还确定了一些发生 N-PSPP 的术前易患因素。
