骨科手术前低剂量阿片类药物治疗引起的痛觉过敏：一项观察性病例对照研究。

Hyperalgesia induced by low-dose opioid treatment before orthopaedic surgery: An observational case-control study.

作者信息

Hina Nabil, Fletcher Dominique, Poindessous-Jazat Frédérique, Martinez Valéria

机构信息

From the Service d'Anesthésie Réanimation Chirurgicale, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, Garches (NH, DF,VM), INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur, Boulogne Billancourt (DF,FP-J,VM), and Université Versailles Saint-Quentin, Versailles, France (DF).

出版信息

Eur J Anaesthesiol. 2015 Apr;32(4):255-61. doi: 10.1097/EJA.0000000000000197.

DOI:10.1097/EJA.0000000000000197

PMID:25485877

Abstract

BACKGROUND

Chronic pain and opioid consumption may trigger diffuse hyperalgesia, but their relative contributions to pain vulnerability remain unclear.

OBJECTIVES

To assess preoperative opioid-induced hyperalgesia and its postoperative clinical consequences in patients with chronic pain scheduled for orthopaedic surgery.

DESIGN

A prospective observational study.

SETTINGS

Raymond Poincare teaching hospital.

PATIENTS

Adults with or without long-term opioid treatment, scheduled for orthopaedic surgery.

PRIMARY OUTCOME MEASURE

Preoperative hyperalgesia was assessed with eight quantitative sensory tests, in a pain-free zone.

SECONDARY OUTCOME MEASURES

Postoperative morphine consumption and pain intensity were evaluated using a numerical rating scale (NRS) in the recovery room and during the first 72 h.

RESULTS

We analysed results from 68 patients (28 opioid-treated patients and 40 controls). Mean daily opioid consumption was 42 ± 25 mg of morphine equivalent. The opioid-treated group displayed significantly higher levels of preoperative hyperalgesia in three tests: heat tolerance threshold (47.1°C vs. 48.4°C; P = 0.045), duration of tolerance to a 47°C stimulus (40.2 vs. 51.1 s; P = 0.03) and mechanical temporal summation [1.79 vs. 1.02 (ΔNRS10-1); P = 0.036]. Patients in the opioid-treated group consumed more morphine (19.1 vs. 9.38 mg; P = 0.001), had a higher pain intensity (7.6 vs. 5.5; P = 0.001) in the recovery room and a higher cumulative morphine dose at 72 h (39.8 vs. 25.6 mg; P = 0.02).

CONCLUSION

Chronic pain patients treated with low doses of opioid had hyperalgesia before surgery. These results highlight the need to personalise the management of patients treated with opioids before surgery.

TRIAL REGISTRATION

ID-RCB 2011-A00304-37.

摘要

背景

慢性疼痛和阿片类药物的使用可能引发弥漫性痛觉过敏，但其对疼痛易感性的相对影响尚不清楚。

目的

评估计划接受骨科手术的慢性疼痛患者术前阿片类药物诱发的痛觉过敏及其术后临床后果。

设计

前瞻性观察研究。

地点

雷蒙德·庞加莱教学医院。

患者

计划接受骨科手术的成年患者，有或无长期阿片类药物治疗史。

主要结局指标

在无痛区域通过八项定量感觉测试评估术前痛觉过敏。

次要结局指标

在恢复室和术后72小时内，使用数字评分量表（NRS）评估术后吗啡消耗量和疼痛强度。

结果

我们分析了68例患者的结果（28例接受阿片类药物治疗的患者和40例对照）。平均每日阿片类药物消耗量为42±25毫克吗啡当量。在三项测试中，接受阿片类药物治疗的组术前痛觉过敏水平显著更高：热耐受阈值（47.1°C对48.4°C；P = 0.045）、对47°C刺激的耐受持续时间（40.2对51.1秒；P = 0.03）和机械性时间总和[1.79对1.02（ΔNRS10-1）；P = 0.036]。接受阿片类药物治疗的组患者在恢复室消耗更多吗啡（19.1对9.38毫克；P = 0.001），疼痛强度更高（7.6对5.5；P = 0.001），且在72小时时累积吗啡剂量更高（39.8对25.6毫克；P = 0.02）。