Abdallah Faraj W, Morgan Pamela J, Cil Tulin, Escallon Jaime M, Semple John L, Chan Vincent W
Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada Department of Surgery, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada Department of Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
Pain. 2015 Apr;156(4):740-749. doi: 10.1097/j.pain.0000000000000108.
Investigating protective strategies against chronic neuropathic pain (CNP) after breast cancer surgery entails using valid screening tools. The DN4 (Douleur Neuropathique en 4 questions) is 1 tool that offers important research advantages. This prospective 6-month follow-up study seeks to validate the DN4 and assess its responsiveness in screening for CNP that satisfies the International Association for the Study of Pain (IASP) definition and fulfills its grading system criteria after breast tumor resection with and without paravertebral blocks (PVBs). We randomized 66 females to standardized general anesthesia and sham subcutaneous injections, or PVB and total intravenous anesthesia. The 6-month CNP risk was assessed using the IASP grading system and the DN4 screening tools. We evaluated the DN4 sensitivity, specificity, and responsiveness in capturing the impact of PVB on the CNP risk relative to the IASP grading system. Data from 64 patients showed similar demographic characteristics in both groups. Twenty patients in both groups met the grading system CNP criteria; among these, 18 patients also met the DN4 CNP criteria. Furthermore, 15 patients in both groups did not meet the grading system CNP criteria; among these, 9 patients also did not meet the DN4 CNP criteria. Therefore, the sensitivity and specificity of the DN4 were estimated at 90% and 60%, respectively. Both screening tools suggested that PVB reduced the 6-month CNP risk. Our results suggest that the DN4 can reliably identify CNP at 6 months after breast tumor resection and detect the preincisional PVB effect on the risk of developing such pain.
研究乳腺癌手术后慢性神经性疼痛（CNP）的预防策略需要使用有效的筛查工具。DN4（Douleur Neuropathique en 4 questions，即四问题神经病理性疼痛量表）是一种具有重要研究优势的工具。这项为期6个月的前瞻性随访研究旨在验证DN4，并评估其在筛查符合国际疼痛研究协会（IASP）定义并满足其分级系统标准的乳腺癌切除术后伴或不伴椎旁阻滞（PVB）的CNP方面的反应性。我们将66名女性随机分为接受标准化全身麻醉和假皮下注射组，或PVB和全静脉麻醉组。使用IASP分级系统和DN4筛查工具评估6个月时的CNP风险。我们评估了DN4在相对于IASP分级系统捕捉PVB对CNP风险影响方面的敏感性、特异性和反应性。64例患者的数据显示两组的人口统计学特征相似。两组各有20例患者符合分级系统的CNP标准；其中，18例患者也符合DN4的CNP标准。此外，两组各有15例患者不符合分级系统的CNP标准；其中，9例患者也不符合DN4的CNP标准。因此，DN4的敏感性和特异性估计分别为90%和60%。两种筛查工具均表明PVB降低了6个月时的CNP风险。我们的结果表明，DN4能够可靠地识别乳腺癌切除术后6个月时的CNP，并检测术前PVB对发生此类疼痛风险的影响。
