Hetmann F, Kongsgaard U E, Sandvik L, Schou-Bredal I
Department of Nursing, Oslo and Akershus University College of Applied Sciences, Oslo, Norway and University of Oslo, Oslo, Norway.
Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway and University of Oslo, Oslo, Norway.
Acta Anaesthesiol Scand. 2015 Jul;59(6):740-8. doi: 10.1111/aas.12532. Epub 2015 Apr 23.
Persistent post-surgical pain is recognised as a major problem. Prevalence after different surgical procedures has been reported to range from 5% up to 85%. Limb amputation and thoracotomy have the highest reported prevalence. Prediction of persistent post-surgical pain has over the last decade caught attention. Several factors have been investigated, but in-depth knowledge is still scarce. The purpose of this study was to investigate the prevalence of persistent post-surgical pain, and predictive factors for persistent post-surgical pain 12 months after thoracotomy.
A prospective longitudinal study was conducted. One-hundred and seventy patients were recruited before scheduled thoracotomy, and asked to answer a questionnaire. One-hundred and six patients completed the same questionnaire at 12-month follow-up. Regression analysis was performed to explore variables assumed predictive of persistent post-surgical pain.
One-hundred and six patients (62%) filled out the questionnaire at both time points. Preoperative, 34% reported muscle-skeletal related chronic pain. At 12-month follow-up, 50% of the patients reported persistent post-surgical pain. Of the variables explored in the logistic regression model, only preoperative pain (P < 0.001) and dispositional optimism (P = 0.04) were statistically significant. In this study, preoperative pain was a predominant predictor for persistent postoperative pain (OR 6.97, CI 2.40-20.21), while dispositional optimism (OR 0.36, CI 0.14-0.96) seem to have protective properties.
Our results show that preoperative pain is a predominant predictor of future pain. This implies that patients presenting with a chronic pain condition prior to surgery should be assessed thoroughly preoperatively and have an individually tailored analgesic regimen.
术后持续性疼痛被认为是一个主要问题。据报道，不同手术操作后的患病率在5%至85%之间。肢体截肢和开胸手术的报告患病率最高。在过去十年中，术后持续性疼痛的预测受到了关注。已经对几个因素进行了研究，但深入的了解仍然很少。本研究的目的是调查开胸手术后12个月持续性术后疼痛的患病率以及持续性术后疼痛的预测因素。
进行了一项前瞻性纵向研究。在预定的开胸手术前招募了170名患者，并要求他们回答一份问卷。106名患者在12个月的随访中完成了相同的问卷。进行回归分析以探索假定可预测术后持续性疼痛的变量。
106名患者（62%）在两个时间点都填写了问卷。术前，34%的患者报告有肌肉骨骼相关的慢性疼痛。在12个月的随访中，50%的患者报告有持续性术后疼痛。在逻辑回归模型中探索的变量中，只有术前疼痛（P < 0.001）和性格乐观（P = 0.04）具有统计学意义。在本研究中，术前疼痛是术后持续性疼痛的主要预测因素（OR 6.97，CI 2.40 - 20.21），而性格乐观（OR 0.36，CI 0.14 - 0.96）似乎具有保护作用。
我们的结果表明，术前疼痛是未来疼痛的主要预测因素。这意味着术前患有慢性疼痛疾病的患者应在术前进行全面评估，并制定个性化的镇痛方案。
