开胸手术后恢复期间更高术后疼痛强度的独立预测因素：621 例患者的回顾性分析。

Independent Predictors for Higher Postoperative Pain Intensity During Recovery After Open Thoracic Surgery: A Retrospective Analysis in 621 Patients.

机构信息

Departments of Anesthesiology and Pain Medicine.

Department of Anesthesiology and Intensive Care Medicine, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany.

出版信息

Pain Med. 2018 Aug 1;19(8):1667-1673. doi: 10.1093/pm/pnx238.

DOI:10.1093/pm/pnx238

PMID:29635531

Abstract

OBJECTIVE

To evaluate two standard procedure-specific pain regimens and to assess independent predictors for higher pain intensity after thoracic surgery.

METHODS

Patients received either oral opioid analgesia (Opioid Group) or epidural analgesia and were then bridged to systemic opioid analgesia (EDA + O Group) in this retrospective observational study. Medical history, discharge letters, anesthetic protocols, and pain protocols were evaluated in 621 patients after open thoracotomy and assessed with a stepward back elimination in a multivariate logistic regression model.

RESULTS

Data of 621 thoracotomies in 2014 were analyzed, 309 patients in the Opioid Group and 312 patients in the EDA + O Group. Pain scores at rest and on coughing were significantly lower in the EDA + O Group on postoperative days (PODs) 1-4 (P < 0.001). Stepwise backward elimination in multivariate logistic regression identified preexisting pain disease (P = 0.034), no epidural analgesia (P < 0.001), opioids in preoperative pain therapy (P < 0.001), and antidepressant medication (P = 0.003) as independent risk factors for higher pain intensity at rest on PODs 1-4. Same on PODs 5-8 with regard to opioids in preoperative pain therapy (P < 0.001) and antidepressant medication (P = 0.018). Moreover, on PODs 5-8, male gender had a lower risk (P < 0.003) for pain, and preexisting musculosceletal disease had a lower risk for more postoperative pain (P = 0.009). On coughing, male gender and younger age proved to have a lower risk for postoperative pain on PODs 1-8 and on PODs 1-4, respectively. Opioids in preexisting pain therapy and antidepressant medication were identified as risk factors for pain on PODs 1-8 on coughing, and pain disease was identified as a risk factor for more pain on PODs 1-4 (P = 0.041). Moreover, preexisting cardiac disease indicated more pain on PODs 1-4 (P = 0.05), and musculoskeletal disease and neurological disease indicated more pain on PODs 5-8 (P = 0.041, and P = 0.023).

CONCLUSIONS

We present data on independent risk factors for higher pain intensity during recovery after thoracotomy. The lack of postoperative epidural analgesia, female gender, preexisting opioid pain therapy, and chronic pain are the strongest risk factors for higher pain intensity. Antidepressant medication was identified as an independent risk factor at rest and on coughing on all PODs.

STUDY LIMITATIONS

The study design is retrospective.

摘要

目的

评估两种标准的特定于手术的疼痛方案，并评估胸外科手术后更高疼痛强度的独立预测因素。

方法

在这项回顾性观察研究中，患者接受口服阿片类药物镇痛（阿片类药物组）或硬膜外镇痛，然后桥接到全身阿片类药物镇痛（EDA+O 组）。评估 621 例开胸手术后患者的病历、出院信、麻醉方案和疼痛方案，并在多变量逻辑回归模型中进行逐步向后消除。

结果

分析了 2014 年 621 例开胸手术的数据，阿片类药物组 309 例，EDA+O 组 312 例。在术后第 1-4 天（PODs），EDA+O 组在休息和咳嗽时的疼痛评分明显较低（P<0.001）。多变量逻辑回归中的逐步向后消除确定了术前疼痛治疗中的预先存在的疼痛疾病（P=0.034）、无硬膜外镇痛（P<0.001）、术前疼痛治疗中的阿片类药物（P<0.001）和抗抑郁药物（P=0.003）是休息时更高疼痛强度的独立危险因素在 PODs 1-4。在 PODs 5-8 时，同样与术前疼痛治疗中的阿片类药物（P<0.001）和抗抑郁药物（P=0.018）有关。此外，在 PODs 5-8 时，男性的疼痛风险较低（P<0.003），预先存在的肌肉骨骼疾病的疼痛风险较低（P=0.009）。在咳嗽时，男性和年轻年龄被证明在 PODs 1-8 和 PODs 1-4 时具有较低的术后疼痛风险。在 PODs 1-8 时，术前疼痛治疗中的阿片类药物和抗抑郁药物被确定为疼痛的危险因素，在 PODs 1-4 时，疼痛疾病被确定为疼痛的危险因素（P=0.041）。此外，术前心脏病表明 PODs 1-4 时疼痛更严重（P=0.05），肌肉骨骼疾病和神经系统疾病表明 PODs 5-8 时疼痛更严重（P=0.041，P=0.023）。