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一半的患者在骨科手术后三个月报告持续疼痛。

One half of patients reports persistent pain three months after orthopaedic surgery.

机构信息

Department of Anaesthesia, Institut Claudius Regaud, IUCT-O, 31059 Toulouse, France; INSERM 1027, Pharmacoepidemiology Research Unit, University of Toulouse, 31000 Toulouse, France.

Department of Anaesthesia and Critical Care, Orthopaedic Center, Purpan University Hospital, 31000 Toulouse, France.

出版信息

Anaesth Crit Care Pain Med. 2015 Jun;34(3):159-64. doi: 10.1016/j.accpm.2014.09.006. Epub 2015 May 23.

Abstract

OBJECTIVE

To determine persistent post-surgical pain prevalence after orthopaedic surgery with its impact on patient quality of life and to assess factors related to it.

STUDY DESIGN

Cross-sectional cohort study.

PATIENTS

A questionnaire was mailed to 2100 patients undergoing orthopaedic surgery in our teaching hospital.

METHODS

Pain prevalence 3 months after surgery, pain intensity, a neuropathic pain component using the DN4 questionnaire and its impact on patient quality of life were assessed.

RESULTS

One thousand two hundred and ninety-two patients answered our questionnaire. Among them, 48% suffered from chronic pain. This pain had a neuropathic component in 43%, which was responsible for analgesic overconsumption and increases in sleep disturbance and sick leave. Arthrodesis, knee arthroplasty and leg fracture were linked to increased chronic post-surgical pain (OR=2.7, OR=1.8, OR=1.9, respectively; P<0.05). Elbow surgery, meniscectomy, amputation and neurolysis were linked to increased neuropathic pain.

CONCLUSIONS

Chronic, post-surgical pain is common after orthopaedic surgery, leading to analgesic consumption and sleep disturbance. Patients at high risk for developing chronic post-surgical pain must be identified preoperatively. The development of postoperative pain clinics should be one way to respond to this public health problem.

摘要

目的

确定骨科手术后持续性术后疼痛的发生率及其对患者生活质量的影响,并评估与之相关的因素。

研究设计

横断面队列研究。

患者

我们向在教学医院接受骨科手术的 2100 名患者邮寄了一份问卷。

方法

评估术后 3 个月的疼痛发生率、疼痛强度、使用 DN4 问卷评估的神经性疼痛成分及其对患者生活质量的影响。

结果

1292 名患者回答了我们的问卷。其中,48%的患者患有慢性疼痛。这种疼痛有 43%的神经性成分,导致镇痛药过度使用以及睡眠障碍和病假增加。关节融合术、膝关节置换术和腿部骨折与慢性术后疼痛增加相关(OR=2.7、OR=1.8、OR=1.9,分别;P<0.05)。肘部手术、半月板切除术、截肢和神经松解术与神经性疼痛增加相关。

结论

骨科手术后常见慢性、术后疼痛,导致镇痛药使用和睡眠障碍。必须在术前识别出有发生慢性术后疼痛风险的患者。应通过设立术后疼痛诊所来应对这一公共卫生问题。

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