DN4 评分评估的术后早期神经病理性疼痛可预测持续性术后神经病理性疼痛的风险增加。
Early postoperative neuropathic pain assessed by the DN4 score predicts an increased risk of persistent postsurgical neuropathic pain.
机构信息
From the CHU Rennes, Pôle Anesthésie et Réanimation, Inserm, UMR 991, CIC 1414 and Université de Rennes 1 (HB), CHU Rennes, Pôle Anesthésie et Réanimation (BS), CHU Rennes, Inserm CIC 1414, Rennes (CR), Pôle Anesthésie Réanimation CHU de Grenoble BP217, Grenoble Cedex 9 (PA), Département d'Anesthésie Réanimation, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris (MR), Hospices civils de Lyon, Université Lyon 1, Groupement hospitalier Nord, Hôpital de la Croix Rousse, Lyon (FA), Service d'Anesthésie Réanimation Chirurgicale, Hôpital Raymond Poincaré, AP-HP (VM); and INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur, Paris, France (VM).
出版信息
Eur J Anaesthesiol. 2017 Oct;34(10):652-657. doi: 10.1097/EJA.0000000000000634.
BACKGROUND
Acute neuropathic pain can occur in the postoperative period but any link with persistent post-surgical neuropathic pain remains unclear.
OBJECTIVES
The objectives of this study were to prospectively describe the incidence of acute post-surgical neuropathic pain in a large population using the DN4 (clinician administered) questionnaire and to confirm the hypothetical link between acute and persistent neuropathic pain at 2 months after surgery in a large population using the DN2 (self administered) questionnaire.
DESIGN
A multi-centre, prospective and observational trial.
SETTING
Two consecutive days in 27 hospitals in France.
PATIENTS
Six hundred and eight patients undergoing 13 different types of surgery. Fifteen patients were excluded as data were incomplete, and 229 (38.6%) and 260 (43.8%) were not contactable for assessment at 1 and 2 months after surgery, respectively.
MAIN OUTCOME MEASURES
Pain was evaluated at least 2 h postoperatively on the same day (D0),on the second day (D2) and at 1 and 2 months after surgery (M1 and M2). Pain was assessed using a 10-point Numeric Rating Scale. If the Numeric Rating Scale score was greater than 0, neuropathic pain was assessed using a DN4 (clinician administered) questionnaire or using a DN2 (self-administered) questionnaire. Acute and persistent postsurgical neuropathic pain (PPSNP) were defined respectively by a DN4 score at least 4/10 on day 0 and/or day 2 and a DN2 score at least 3/7 at 2 months after surgery.
RESULTS
Of the 593 patients included, 41.2% were in pain before surgery and 8.2% described neuropathic pain. Early after surgery, the majority of the 593 patients (72.2% on the day of surgery and 71.3% on day 2) experienced acute pain. It was neuropathic in nature in 5.6% of patients (95% CI, 3.6 to 8.3) on the day of surgery and 12.9% (95% CI, 9.7 to 16.7) on day 2. Two months after surgery, PPSNP was present in 33.3% of the 333 patients assessed. Multivariate analysis showed that a DN4 score at least 4/10 on the day of surgery or on day 2 was a significant risk factor for PPSNP [odds ratios 4.22 (95% CI, 2.19 to 8.12)].
CONCLUSION
Our results suggest that early acute postsurgical neuropathic pain significantly increases the risk of persistent post-surgical neuropathic pain.
TRIAL REGISTRATION
Clinicaltrials.gov identifier: NTC NCT02826317.
背景
术后可能会发生急性神经病理性疼痛，但与持续性术后神经病理性疼痛之间的任何联系仍不清楚。
目的
本研究旨在使用 DN4（临床医生管理）问卷前瞻性地描述大量人群中术后急性神经病理性疼痛的发生率，并使用 DN2（自我管理）问卷在大量人群中确认术后 2 个月时急性和持续性神经病理性疼痛之间的假设联系。
设计
多中心、前瞻性和观察性试验。
地点
法国 27 家医院连续两天。
患者
608 例接受 13 种不同类型手术的患者。15 名患者因数据不完整而被排除，分别有 229 名（38.6%）和 260 名（43.8%）在术后 1 个月和 2 个月时无法联系进行评估。
主要观察指标
术后至少 2 小时在同一天（D0）、第二天（D2）以及术后 1 个月和 2 个月（M1 和 M2）评估疼痛。疼痛使用 10 分数字评分量表进行评估。如果数字评分量表的评分大于 0，则使用 DN4（临床医生管理）问卷或 DN2（自我管理）问卷评估神经性疼痛。急性和持续性术后神经病理性疼痛（PPSNP）分别定义为术后第 0 天和第 2 天 DN4 评分至少 4/10 和/或术后 2 个月 DN2 评分至少 3/7。
结果
在纳入的 593 例患者中，41.2%的患者术前有疼痛，8.2%的患者描述为神经性疼痛。术后早期，593 例患者中的大多数（手术当天 72.2%，第 2 天 71.3%）经历了急性疼痛。手术当天 5.6%（95%CI，3.6%至 8.3%）和第 2 天 12.9%（95%CI，9.7%至 16.7%）的患者疼痛为神经性。术后 2 个月时，333 例接受评估的患者中有 33.3%存在 PPSNP。多变量分析显示，手术当天或第 2 天 DN4 评分至少 4/10 是 PPSNP 的显著危险因素[比值比 4.22（95%CI，2.19 至 8.12）]。
结论
我们的结果表明，早期急性术后神经病理性疼痛显著增加了持续性术后神经病理性疼痛的风险。
试验注册
Clinicaltrials.gov 标识符：NTC NCT02826317。
Zotero 插件