Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California.
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Pain Med. 2019 Jan 1;20(1):161-171. doi: 10.1093/pm/pny020.
To identify factors associated with pain severity and opioid consumption in the early perioperative period.
Prospective observational cohort study.
Tertiary academic medical center.
Patients with osteoarthritis older than age 45 years undergoing primary total knee replacement at Brigham and Women's Hospital. A total of 126 patients enrolled.
Preoperatively, pain questionnaires and quantitative sensory testing were performed on patients to develop a psychosocial and psychophysical profile. Postoperatively, pain scores and opioid consumption were measured as primary end points. Univariate and multiple linear regression analyses were performed to determine the predictive value of these characteristics on perioperative pain scores and opioid consumption.
Regression analysis revealed several predictors of acute postoperative pain scores including temporal summation of pain (TSP; P = 0.001), body mass index (BMI; P = 0.044), number of previous knee surgeries (P = 0.006), and female gender (P = 0.023). Similarly, predictors of opioid utilization included TSP (P = 0.011), BMI (P = 0.02), age (P = <0.001), and tourniquet time (P = 0.003).
The only significant, unique predictors of both pain and opioid consumption were TSP, an index of central pain facilitatory processes, and BMI. Interestingly, psychosocial factors, such as catastrophizing and somatization, although correlated with postoperative pain scores and opioid consumption, generally did not independently explain substantial variance in these measures. This study suggests that BMI and quantitative sensory testing, specifically the temporal summation of pain, may provide value in the preoperative assessment of patients undergoing total knee arthroplasty and other surgeries via predicting their level of risk for adverse pain outcomes.
确定与围手术期早期疼痛严重程度和阿片类药物消耗相关的因素。
前瞻性观察队列研究。
三级学术医疗中心。
在布莱根妇女医院接受初次全膝关节置换术的年龄大于 45 岁的骨关节炎患者。共有 126 名患者入组。
在术前，对患者进行疼痛问卷和定量感觉测试，以制定心理社会和心理物理特征。术后，将疼痛评分和阿片类药物消耗量作为主要终点进行测量。进行单变量和多元线性回归分析，以确定这些特征对围手术期疼痛评分和阿片类药物消耗的预测价值。
回归分析显示，急性术后疼痛评分的几个预测因素包括疼痛时间总和（TSP；P=0.001）、体重指数（BMI；P=0.044）、既往膝关节手术次数（P=0.006）和女性性别（P=0.023）。同样，阿片类药物使用的预测因素包括 TSP（P=0.011）、BMI（P=0.02）、年龄（P=<0.001）和止血带时间（P=0.003）。
唯一显著的、独特的疼痛和阿片类药物消耗的预测因素是 TSP，这是一种中枢疼痛促进过程的指标，以及 BMI。有趣的是，心理社会因素，如灾难化和躯体化，虽然与术后疼痛评分和阿片类药物消耗相关，但通常不能独立解释这些测量指标的大量差异。本研究表明，BMI 和定量感觉测试，特别是疼痛时间总和，可能通过预测全膝关节置换术和其他手术患者发生不良疼痛结局的风险水平，为这些患者的术前评估提供价值。
