Aschenbrenner Carol A, Houle Timothy T, Gutierrez Silvia, Eisenach James C
From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Anesthesiology. 2014 Nov;121(5):1056-67. doi: 10.1097/ALN.0000000000000360.
Recovery from pain after surgery exhibits large interindividual variability, with very slow recovery equated to chronic pain. Surgical injury in the postpartum period modestly increases initial recovery after major nerve injury. In this study, the authors use a nerve injury that recovers over 2 to 3 months and apply growth curve modeling to further understand the effect of the postpartum period on speed of recovery.
Withdrawal threshold to mechanical stimulus on the hind paw was determined in 41 Sprague-Dawley rats before and for 10 weeks after partial spinal nerve ligation. Age-matched male and female rats and postpartum females with pups or those separated from pups at delivery were studied. Growth curve analyses were applied to model recovery after surgery despite varying timing of measurements across groups and missing data, and these results were compared with those of two-way repeated-measures ANOVA.
The recovery time course was similar between males and females. In contrast, recovery was hastened in the postpartum groups, with nonoverlapping 95% CIs of modeled trajectories between days 6 and 66 after surgery. CIs were more precise at most time periods with growth curve analysis compared with ANOVA.
The authors describe a method of analysis to quantify recovery from hypersensitivity after surgery in rats with several distinct advantages over traditionally used methods. Study results do not support a sex difference in trajectory of recovery but confirm and extend previous observations that injury at the time of obstetric delivery is associated with an abnormally rapid recovery.
手术后疼痛的恢复存在很大的个体差异,恢复非常缓慢等同于慢性疼痛。产后手术损伤会适度加快主要神经损伤后的初期恢复。在本研究中,作者使用一种在2至3个月内恢复的神经损伤,并应用生长曲线模型来进一步了解产后时期对恢复速度的影响。
在41只Sprague-Dawley大鼠进行部分脊神经结扎术前及术后10周,测定其后爪对机械刺激的撤针阈值。研究了年龄匹配的雄性和雌性大鼠以及产后带幼崽的雌性大鼠或分娩时与幼崽分离的雌性大鼠。尽管各组测量时间不同且存在缺失数据,但仍应用生长曲线分析对手术后的恢复进行建模,并将这些结果与双向重复测量方差分析的结果进行比较。
雄性和雌性的恢复时间进程相似。相比之下,产后组的恢复加快,术后第6天至66天之间建模轨迹的95%置信区间不重叠。与方差分析相比,生长曲线分析在大多数时间段的置信区间更精确。
作者描述了一种分析方法,用于量化大鼠手术后超敏反应的恢复情况,该方法相对于传统方法具有几个明显优势。研究结果不支持恢复轨迹存在性别差异,但证实并扩展了先前的观察结果,即产科分娩时的损伤与异常快速的恢复有关。