Rozet Irene, Nishio Isuta, Robbertze Reinette, Rotter Douglas, Chansky Howard, Hernandez Adrian V
From the Department of Anesthesiology and Pain Medicine, University of Washington; Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington; and Department of Quantitative Health Sciences, Health Outcomes and Clinical Epidemiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
Anesth Analg. 2014 Aug;119(2):454-459. doi: 10.1213/ANE.0000000000000292.
Chronic postoperative pain occurs with an appreciable incidence after elective surgery. Known risk factors include perioperative pain and posttraumatic stress disorder (PTSD). Military veterans are a population at particular risk for PTSD and hence may be at increased risk for chronic pain after surgery. Our goal was to identify risk factors for chronic postoperative pain in young veterans after minor elective surgery, including the contribution of PTSD.
We reviewed the medical and pharmacy records of veterans (18-50 years old), undergoing elective knee arthroscopy from 2007 to 2010 at the Veteran's Administration Puget Sound Health Care System. The data included demographics, ASA physical status class, comorbidities, anesthesia medications, and opioid prescriptions starting 3.5 months before surgery and ending 3.5 months after surgery. We documented the presence of PTSD based on either the patient's problem list or the clinical notes. We used prolonged postoperative opioid prescription longer than 3 months after surgery as a surrogate for chronic postoperative pain.
We identified 145 patients who met inclusion criteria. The median age was 39 ± 8 years old. Eighty-seven percent of the patients were men. The prevalence of PTSD was 32% (95% confidence interval, 25%-41%). PTSD was associated with increased incidence of smoking (P = 0.009) and preoperative opioid use (P = 0.0006). Preoperative opioids were prescribed in 44% (63 of 145) of the patients: in 64% (30 of 47) of patients with PTSD, compared with 34% (33 of 98) in patients without PTSD (P = .0006). Chronic postoperative pain was identified in 30% (43 of 145) of patients. The strongest independent predictor of chronic postoperative pain was an opioid prescription before surgery (odds ratio = 65.3; 95% confidence interval, 014.5-293.0). In patients older than 27.5 years who did not receive opioids before surgery, PTSD may also have been a risk factor for chronic postoperative pain.
This single-center retrospective study suggests that the most important predictor of chronic postoperative pain is preoperative opioid use. For patients not taking opioids preoperatively, PTSD may increase the risk of prolonged postoperative opioid prescriptions and chronic postoperative pain, potentially related to patient age.
择期手术后慢性术后疼痛的发生率较高。已知的风险因素包括围手术期疼痛和创伤后应激障碍（PTSD）。退伍军人是患PTSD风险特别高的人群，因此术后慢性疼痛的风险可能增加。我们的目标是确定年轻退伍军人在进行小型择期手术后发生慢性术后疼痛的风险因素，包括PTSD的影响。
我们回顾了2007年至2010年在退伍军人事务部普吉特海湾医疗保健系统接受择期膝关节镜检查的退伍军人（18 - 50岁）的医疗和药房记录。数据包括人口统计学信息、美国麻醉医师协会（ASA）身体状况分级、合并症、麻醉药物以及术前3.5个月至术后3.5个月的阿片类药物处方。我们根据患者的问题列表或临床记录记录PTSD的存在情况。我们将术后阿片类药物处方延长超过术后3个月作为慢性术后疼痛的替代指标。
我们确定了145名符合纳入标准的患者。中位年龄为39±8岁。87%的患者为男性。PTSD的患病率为32%（95%置信区间，25% - 41%）。PTSD与吸烟发生率增加（P = 0.009）和术前使用阿片类药物（P = 0.0006）相关。44%（145名患者中的63名）的患者术前开具了阿片类药物：PTSD患者中64%（47名患者中的30名）开具了阿片类药物，而无PTSD患者中这一比例为34%（98名患者中的33名）（P = 0.0006）。30%（145名患者中的43名）的患者被确定存在慢性术后疼痛。慢性术后疼痛最强的独立预测因素是术前阿片类药物处方（比值比 = 65.3；95%置信区间，14.5 - 293.0）。在术前未接受阿片类药物的27.5岁以上患者中，PTSD也可能是慢性术后疼痛的一个风险因素。
这项单中心回顾性研究表明，慢性术后疼痛最重要的预测因素是术前阿片类药物的使用。对于术前未服用阿片类药物的患者，PTSD可能会增加术后阿片类药物处方延长和慢性术后疼痛的风险，这可能与患者年龄有关。
