Sari Sinem, Kozanhan Betul, Egilmez Ayse Ilksen, Soyder Aykut, Aydin Osman Nuri, Galimberti Fabrizio, Sessler Daniel, Turan Alparslan
Adnan Menderes University Medical Faculty, Department of Anesthesiology and Reanimation, Aydin, Turquia.
University of Health Sciences, Konya Education and Research Hospital, Department of Anesthesiology and Reanimation, Konya, Turquia.
Braz J Anesthesiol. 2018 May-Jun;68(3):231-237. doi: 10.1016/j.bjan.2017.11.001. Epub 2018 Jan 17.
BACKGROUND AND OBJECTIVES: Fluctuations of female sex hormones during menstrual cycle influence pain perception. Endogenous pain inhibition is impaired in follicular phase of menstrual cycle. We tested the primary hypothesis that the women having surgery during their follicular phase have more acute pain and require higher opioids than those in the luteal phase, and secondarily we tested that women who have surgery during their follicular phase have more incisional pain at 3 month postoperatively. METHODS: 127 adult females having laparoscopic cholecystectomy were randomized to have surgery during the luteal or follicular phase of their menstrual cycle. Standardized anesthesia and pain management regimen was given to all patients. Pain and analgesic consumption were evaluated in post-anesthesia care unit and every 4 h in the first 24 h. Adverse effects were questioned every 4 h. Time to oral intake and ambulation were recorded. Post-surgical pain, hospital anxiety, depression scale, SF-12 questionnaire were evaluated at 1 and 3 month visits. RESULTS: There was no difference in acute pain scores and analgesic consumption through the 24 h period, Visual Analog Scale at 24 h was 1.5 ± 1.5 cm for follicular group 1.4 ± 1.7 cm for luteal group ( = 0.57). Persistent postoperative pain was significantly more common one and at three month, with an incidence was 33% and 32% in the patients at follicular phase versus 16% and 12% at luteal phase, respectively. The Visual Analog Scale at one and at three month was 1.6 ± 0.7 cm and 1.8 ± 0.8 cm for follicular group and 2.7 ± 1.3 cm and 2.9 ± 1.7 cm in the luteal group ( = 0.02), respectively. There were no significant differences between the groups with respect to anxiety and depression, SF-12 scores at either time. Nausea was more common in follicular-phase group ( = 0.01) and oral feeding time was shorter in follicular phase (5.9 ± 0.9 h) than in luteal phase (6.8 ± 1.9 h, = 0.02). CONCLUSIONS: Although persistent postoperative pain was significantly more common one and three months after surgery the magnitude of the pain was low. Our results do not support scheduling operations to target particular phases of the menstrual cycle.
背景与目的：月经周期中女性性激素的波动会影响疼痛感知。月经周期卵泡期的内源性疼痛抑制功能受损。我们检验了主要假设，即处于卵泡期接受手术的女性比处于黄体期接受手术的女性有更剧烈的急性疼痛且需要更高剂量的阿片类药物，其次我们检验了处于卵泡期接受手术的女性在术后3个月时有更多的切口疼痛。 方法：127名接受腹腔镜胆囊切除术的成年女性被随机分为在月经周期的黄体期或卵泡期接受手术。所有患者均采用标准化的麻醉和疼痛管理方案。在麻醉后护理单元以及术后24小时内每4小时评估一次疼痛和镇痛药消耗情况。每4小时询问一次不良反应情况。记录开始经口进食时间和下床活动时间。在术后1个月和3个月复诊时评估手术疼痛、医院焦虑抑郁量表、SF-12问卷情况。 结果：在24小时期间，两组的急性疼痛评分和镇痛药消耗量无差异，卵泡期组24小时视觉模拟量表评分为1.5±1.5厘米，黄体期组为1.4±1.7厘米（P=0.57）。术后持续性疼痛在术后1个月和3个月时明显更常见，卵泡期患者的发生率分别为33%和32%，而黄体期患者分别为16%和12%。卵泡期组术后1个月和3个月时视觉模拟量表评分分别为1.6±0.7厘米和1.8±0.8厘米，黄体期组分别为2.7±1.3厘米和2.9±1.7厘米（P=0.02）。两组在焦虑、抑郁、SF-12评分方面在任何时间均无显著差异。恶心在卵泡期组更常见（P=0.01），卵泡期经口进食时间（5.9±0.9小时）短于黄体期（6.8±1.9小时，P=0.02）。 结论：虽然术后持续性疼痛在术后1个月和3个月时明显更常见，但疼痛程度较低。我们的结果不支持根据月经周期的特定阶段来安排手术。
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