Thomazeau J, Rouquette A, Martinez V, Rabuel C, Prince N, Laplanche J L, Nizard R, Bergmann J F, Perrot S, Lloret-Linares C
INSERM 987, Physiopathologie et pharmacologie clinique de la douleur, Ambroise Paré, Paris, France.
Assistance Publique-Hôpitaux de Paris, Therapeutic Research Unit, Department of Internal Medicine, Hôpital Lariboisière, Paris, France.
Eur J Pain. 2016 May;20(5):822-32. doi: 10.1002/ejp.808. Epub 2015 Oct 30.
Despite the development of multimodal analgesia for postoperative pain management, opioids are still required for effective pain relief after knee arthroplasty. We aimed to identify the determinants of post-operative pain intensity and post-operative opioid requirement in this context.
In this observational prospective study, we recorded patient characteristics, pre-operative pain intensity, anxiety and depression levels, sensitivity and pain thresholds in response to an electrical stimulus, and mu-opioid receptor (OPRM1) and catechol-O-methyltransferase (COMT) single-nucleotide polymorphisms. Multivariate linear regression models were used to identify predictors of post-operative pain at rest and opioid requirement.
We included 109 patients. Pre-operative pain at rest (p = 0.047), anxiety level (p = 0.001) and neuropathic pain symptoms (p = 0.030) were independently and positively associated with mean post-operative pain intensity adjusted for mean post-operative morphine equivalent dose (MED). Mean post-operative pain intensity at rest was lower (p = 0.006) in patients receiving celecoxib and pregabalin in the post-operative period, with all other variables constant. Mean post-operative MED over 5 days was low, but highly variable (78.2 ± 32.1 mg, from 9.9 to 170 mg). Following adjustment for mean post-operative pain intensity, it was independently negatively correlated with age (p = 0.004), and positively correlated with associated paracetamol treatment (p = 0.031). No genetic effect was detected in our sample.
Our findings suggest that clinicians could use the pre-operative pain profile, in terms of anxiety levels, neuropathic pain symptoms, and chronic pre-operative pain intensity, to improve the efficacy of pain management after knee surgery.
尽管已开发出多模式镇痛用于术后疼痛管理，但膝关节置换术后仍需要使用阿片类药物来有效缓解疼痛。在此背景下，我们旨在确定术后疼痛强度和术后阿片类药物需求量的决定因素。
在这项观察性前瞻性研究中，我们记录了患者的特征、术前疼痛强度、焦虑和抑郁水平、对电刺激的敏感性和疼痛阈值，以及μ-阿片受体（OPRM1）和儿茶酚-O-甲基转移酶（COMT）单核苷酸多态性。使用多元线性回归模型来确定静息时术后疼痛和阿片类药物需求量的预测因素。
我们纳入了109例患者。术前静息痛（p = 0.047）、焦虑水平（p = 0.001）和神经性疼痛症状（p = 0.030）与经术后吗啡等效剂量（MED）调整后的平均术后疼痛强度独立且呈正相关。在所有其他变量不变的情况下，术后接受塞来昔布和普瑞巴林治疗的患者静息时的平均术后疼痛强度较低（p = 0.006）。术后5天的平均MED较低，但差异很大（78.2±32.1mg，范围为9.9至170mg）。在调整术后平均疼痛强度后，其与年龄呈独立负相关（p = 0.004），与对乙酰氨基酚联合治疗呈正相关（p = 0.031）。在我们的样本中未检测到基因效应。
我们的研究结果表明，临床医生可以根据焦虑水平、神经性疼痛症状和术前慢性疼痛强度等术前疼痛情况，来提高膝关节手术后疼痛管理的效果。
