甲泼尼龙不能减轻心脏手术后的持续疼痛。

Methylprednisolone Does Not Reduce Persistent Pain after Cardiac Surgery.

机构信息

From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (A.T., D.I.S., J.-P.Y., V.N., S.A.); Departments of Clinical Epidemiology and Biostatistics (E.P.B.-C., P.J.D., A.L., R.P.W.) and Medicine (P.J.D., S.Y.), McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.V., P.J.D., S.Y., A.L., R.P.W.); Department of Surgery, Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (R.v.O., G.C., A.L., R.P.W.); Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China (H.Y.); Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada (J.-F.L.); Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia (A. Royse); Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada (A. Rochon); and Department of Surgery, London Health Sciences Centre, London, Ontario, Canada (M.Q.).

出版信息

Anesthesiology. 2015 Dec;123(6):1404-10. doi: 10.1097/ALN.0000000000000915.

DOI:10.1097/ALN.0000000000000915

PMID:26501386

Abstract

BACKGROUND

Persistent incisional pain is common after cardiac surgery and is believed to be in part related to inflammation and poorly controlled acute pain. Methylprednisolone is a corticosteroid with substantial antiinflammatory and analgesic properties and is thus likely to ameliorate persistent surgical pain. Therefore, the authors tested the primary hypothesis that patients randomized to methylprednisolone have less persistent incisional pain than those given placebo.

METHODS

One thousand forty-three patients having cardiopulmonary bypass for cardiac surgery via a median sternotomy were included in this substudy of Steroids in Cardiac Surgery (SIRS) trial. Patients were randomized to 500 mg intraoperative methylprednisolone or placebo. Incisional pain was assessed at 30 days and 6 months after surgery, and the potential risk factors were also evaluated.

RESULTS

Methylprednisolone administration did not reduce pain at 30 days or persistent incisional pain at 6 months, which occurred in 78 of 520 patients (15.7%) in the methylprednisolone group and in 88 of 523 patients (17.8%) in the placebo group. The odds ratio for methylprednisolone was 0.93 (95% CI, 0.79 to 1.09, P = 0.37). Furthermore, there was no difference in worst pain and average pain in the last 24 h, pain interference with daily life, or use of pain medicine at 6 months. Younger age, female sex, and surgical infections were associated with the development of persistent incisional pain.

CONCLUSIONS

Intraoperative methylprednisolone administration does not reduce persistent incisional pain at 6 months in patients recovering from cardiac surgery.

摘要

背景

心脏手术后持续性切口疼痛很常见，部分原因被认为与炎症和急性疼痛控制不佳有关。甲泼尼龙是一种具有显著抗炎和镇痛作用的皮质类固醇，因此可能会改善持续性手术疼痛。因此，作者检验了主要假设，即接受甲泼尼龙治疗的患者比接受安慰剂治疗的患者持续性切口疼痛更少。

方法

这项 Steroids in Cardiac Surgery（SIRS）试验的子研究纳入了 1043 名接受正中开胸经体外循环心脏手术的患者。患者被随机分为术中接受 500mg 甲泼尼龙或安慰剂。术后 30 天和 6 个月评估切口疼痛，同时评估潜在的危险因素。

结果

甲泼尼龙给药并未降低术后 30 天的疼痛或 6 个月时的持续性切口疼痛，在甲泼尼龙组 520 例患者中有 78 例（15.7%）和安慰剂组 523 例患者中有 88 例（17.8%）发生。甲泼尼龙的优势比为 0.93（95%CI，0.79 至 1.09，P=0.37）。此外，在 6 个月时，最差疼痛和最后 24 小时平均疼痛、疼痛对日常生活的干扰或止痛药的使用均无差异。年龄较小、女性和手术感染与持续性切口疼痛的发生有关。