Persson Anna K M, Dyrehag Lars-Erik, Åkeson Jonas
*Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, Malmö †Department of Anaesthesiology and Intensive Care Medicine, Hallands Sjukhus Halmstad, Halmstad, Sweden.
Clin J Pain. 2017 Feb;33(2):126-131. doi: 10.1097/AJP.0000000000000394.
Early postoperative pain correlates to persisting pain, psychosocial distress, and delayed mobilization with thromboembolic and infectious complications. Electrical pain thresholds (EPT) have shown promising results in being able to predict postoperative pain, but the results are conflicting. The aim of this study was to test whether EPT levels can be used to predict the postoperative pain in patients of both sexes.
One hundred eighty patients scheduled for laparoscopic cholecystectomy were included in this prospective clinical study. Individual levels of EPT were measured before surgery, and the pain intensity was evaluated in the early postoperative period.
There were significant correlations between EPT and the maximum postoperative pain intensity (rs=-0.21, P=0.009), time to the first rescue opioid (rs=0.26, P=0.006), and the total dose of rescue opioid (rs=-0.22, P=0.001). The interaction test showed significant influence of the sex on the ability of EPT to predict the postoperative pain intensity. Female patients with low EPT (<15) had a 4.5 times higher risk of postoperative pain (P=0.003).
Levels of EPT are reproducible, and the technique is well tolerated. However, it can be used to predict postoperative pain only in women. A weak correlation with the postoperative pain intensity, found here as well as previously, and the high sex dependency of the EPT levels obtained considerably limit the predictive value of this technique for routine use in perioperative clinical practice.
术后早期疼痛与持续性疼痛、心理社会困扰以及血栓栓塞和感染并发症导致的活动延迟相关。电痛阈（EPT）在预测术后疼痛方面已显示出有前景的结果，但结果相互矛盾。本研究的目的是测试EPT水平是否可用于预测男女患者的术后疼痛。
本前瞻性临床研究纳入了180例计划行腹腔镜胆囊切除术的患者。术前测量个体EPT水平，并在术后早期评估疼痛强度。
EPT与术后最大疼痛强度（rs=-0.21，P=0.009）、首次使用急救阿片类药物的时间（rs=0.26，P=0.006）以及急救阿片类药物的总剂量（rs=-0.22，P=0.001）之间存在显著相关性。交互作用测试显示性别对EPT预测术后疼痛强度的能力有显著影响。EPT低（<15）的女性患者术后疼痛风险高4.5倍（P=0.003）。
EPT水平具有可重复性，且该技术耐受性良好。然而，它仅能用于预测女性的术后疼痛。此处以及之前发现的与术后疼痛强度的弱相关性，以及所获得的EPT水平的高度性别依赖性，极大地限制了该技术在围手术期临床实践中常规使用的预测价值。
