Bayman Emine Ozgur, Brennan Timothy J
Departments of Anesthesia and Biostatistics, University of Iowa, Iowa City, Iowa.
Departments of Anesthesia and Biostatistics, University of Iowa, Iowa City, Iowa.
J Pain. 2014 Sep;15(9):887-97. doi: 10.1016/j.jpain.2014.06.005. Epub 2014 Jun 23.
This systematic review was performed to determine the incidence and the severity of chronic pain at 3 and 6 months after thoracotomy based on meta-analyses. We conducted MEDLINE, Web of Science, and Google Scholar searches of databases and references for English articles; 858 articles were reviewed. Meta-regression analysis based on the publication year was used to examine if the chronic pain rates changed over time. Event rates and confidence intervals with random effect models and Freeman-Tukey double arcsine variance-stabilizing transformation were obtained separately for the incidence of chronic pain based on 1,439 patients from 17 studies at 3 months and 1,354 patients from 15 studies at 6 months. The incidences of chronic pain at 3 and 6 months after thoracotomy were 57% (95% confidence interval [CI], 51-64%) and 47% (95% CI, 39-56%), respectively. The average severity of pain ratings on a 0 to 100 scale at these times were 30 ± 2 (95% CI, 26-35) and 32 ± 7 (95% CI, 17-46), respectively. Reported chronic pain rates have been largely stable at both 3 and 6 months from the 1990s to the present.
This systematic review's findings suggest that reported chronic pain rates are approximately 50% at 3 and 6 months and have been largely stable from the 1990s to the present. The severity of this pain is not consistently reported. Chronic pain after thoracotomy continues to be a significant problem despite advancing perioperative care.
本系统评价旨在通过荟萃分析确定开胸术后3个月和6个月慢性疼痛的发生率及严重程度。我们在MEDLINE、科学网和谷歌学术数据库中检索英文文章及参考文献;共检索到858篇文章。采用基于发表年份的荟萃回归分析来检验慢性疼痛发生率是否随时间变化。分别采用随机效应模型和弗里曼-图基双反正弦方差稳定转换,根据17项研究中的1439例患者在3个月时的情况以及15项研究中的1354例患者在6个月时的情况,得出慢性疼痛发生率的事件率和置信区间。开胸术后3个月和6个月慢性疼痛的发生率分别为57%(95%置信区间[CI],51 - 64%)和47%(95%CI,39 - 56%)。此时疼痛评分在0至100分的平均严重程度分别为30±2(95%CI,26 - 35)和32±7(95%CI,17 - 46)。从20世纪90年代至今,报告的慢性疼痛发生率在3个月和6个月时基本稳定。
本系统评价的结果表明,报告的慢性疼痛发生率在3个月和6个月时约为50%,从20世纪90年代至今基本稳定。这种疼痛的严重程度报告并不一致。尽管围手术期护理有所进步,但开胸术后慢性疼痛仍然是一个重大问题。