Suffeda Alexander, Meissner Winfried, Rosendahl Jenny, Guntinas-Lichius Orlando
Department of Otorhinolaryngology Department of Anesthesiology and Intensive Care Medicine Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany.
Medicine (Baltimore). 2016 Jul;95(28):e4256. doi: 10.1097/MD.0000000000004256.
The aim was to assess the association between objectified preoperative psychological factors and postoperative pain at the first day after otolaryngological surgery in accordance with other predictors of postoperative pain. Eighty-two (82) patients (59% male, median age 56 years) were included between January and May 2015. The psychological assessment the day before surgery included the Patient Health Questionnaire (PHQ-9), pain catastrophizing scale (PCS), State-Trait Operation Anxiety (STOA) inventory, and the resilience scale (RS-13). On first postoperative day, patients were rated their pain using the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including a numeric rating scale (NRS, 0-10) for determination of patient's maximal pain. QUIPS allowed standardized assessment of patients' characteristics, pain parameters, and outcome. The influence of preoperative and postoperative parameters on patients' maximal postoperative pain was estimated by univariate and multivariate statistical analysis. The mean maximal pain was 3.2 ± 2.9. In univariate analysis, higher PHQ-9 score more than 4 (P = 0.010), higher STOA trait anxiety (P = 0.044), and higher STOA total score (P = 0.043) were associated to more postoperative pain. In multivariate analysis higher PHQ-9 score remained an independent predictor for severe pain (beta = 0.302; 95% confidence interval [CI]: 0.054-0.473; P = 0.014). When all parameters were included into multivariate analysis, 2 of all somatic, psychological, and treatment factors were associated with severe maximal pain: more depression (PHQ-9; beta = 0.256; 95% CI: 0.042-0.404; P = 0.017), and use of opioids in the recovery room (beta = 0.371; 95% CI: 0.108-0.481; P = 0.002). Otolaryngological surgery covers the spectrum from low to severe postoperative pain and is therefore a good model for pain management studies. A set of somatic and psychological parameters seems to allow the identification of patients with higher risk for more postoperative pain. This should help to individualize and improve the perioperative pain management.
本研究旨在根据术后疼痛的其他预测因素，评估耳鼻喉科手术后第一天客观化的术前心理因素与术后疼痛之间的关联。2015年1月至5月期间纳入了82例患者（男性占59%，中位年龄56岁）。手术前一天的心理评估包括患者健康问卷（PHQ-9）、疼痛灾难化量表（PCS）、状态-特质手术焦虑（STOA）量表以及复原力量表（RS-13）。术后第一天，患者使用德国全国性术后疼痛治疗质量改进项目（QUIPS）的问卷对疼痛进行评分，该问卷包括一个数字评分量表（NRS，0-10），用于确定患者的最大疼痛程度。QUIPS允许对患者的特征、疼痛参数和结果进行标准化评估。通过单因素和多因素统计分析评估术前和术后参数对患者术后最大疼痛的影响。平均最大疼痛程度为3.2±2.9。在单因素分析中，PHQ-9得分高于4（P = 0.010）、STOA特质焦虑得分较高（P = 0.044）以及STOA总分较高（P = 0.043）与更多的术后疼痛相关。在多因素分析中，较高的PHQ-9得分仍然是严重疼痛的独立预测因素（β = 0.302；95%置信区间[CI]：0.054-0.473；P = 0.014）。当将所有参数纳入多因素分析时，所有躯体、心理和治疗因素中有2个与严重的最大疼痛相关：更多的抑郁（PHQ-9；β = 0.256；95%CI：0.042-0.404；P = 0.017）以及在恢复室使用阿片类药物（β = 0.371；95%CI：0.108-0.481；P = 0.002）。耳鼻喉科手术涵盖了从轻度到重度术后疼痛的范围，因此是疼痛管理研究的良好模型。一组躯体和心理参数似乎有助于识别术后疼痛更严重风险较高的患者。这应该有助于实现围手术期疼痛管理的个体化并加以改善。
