Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom.
Department of Electrical and Electronic Engineering, Imperial College London, London, United Kingdom.
J Vasc Surg Venous Lymphat Disord. 2019 May;7(3):382-386. doi: 10.1016/j.jvsv.2018.08.008. Epub 2019 Jan 3.
Local anesthetic endovenous procedures were shown to reduce recovery time, to decrease postoperative pain, and to more quickly return the patient to baseline activities. However, a substantial number of patients experience pain during these procedures. The autonomic nervous system modulates pain perception, and its influence on stress response can be noninvasively quantified using heart rate variability (HRV) indices. The aim of our study was to evaluate whether preoperative baseline HRV can predict intraoperative pain during local anesthetic varicose vein surgery.
Patients scheduled for radiofrequency ablation were included in the study. They had their electrocardiograms recorded from a single channel of a custom-made amplifier. Each patient preoperatively filled in forms Y-1 and Y-2 of Spielberger's State and Trait Anxiety Inventory, completed the Aberdeen Varicose Vein Questionnaire, and rated anxiety level on a numeric scale. Postoperatively, patients filled in the pain they felt during the procedure on the numeric pain intensity scale. MATLAB software (MathWorks, Natick, Mass) was used to extract R waves and to generate HRV signals, and a mathematical model was created to predict the pain score for each patient.
In multivariable analysis, we looked into correlation between reported patient's pain score (rPPS) and Aberdeen Varicose Vein Questionnaire score, preoperative forms Y-1 and Y-2, preoperative anxiety level, and predicted patient's pain (pPPS) score. Multivariable analysis found association only between rPPS and pPPS. The pPPS was significantly correlated with rPPS (R = 0.807; P < .001) with accuracy of prediction of 65.2%, which was calculated from R on a linear regression model.
This preliminary study shows that preoperative HRV can accurately predict patients' pain, allowing patients with higher predicted score to have the procedure under general anesthesia.
局部麻醉静脉内程序被证明可以减少恢复时间，减轻术后疼痛，并使患者更快地恢复到基线活动水平。然而，相当数量的患者在这些程序中感到疼痛。自主神经系统调节疼痛感知，其对应激反应的影响可以使用心率变异性（HRV）指数进行非侵入性量化。我们研究的目的是评估术前基础 HRV 是否可以预测局部麻醉静脉曲张手术中的术中疼痛。
纳入计划接受射频消融术的患者。他们的心电图由定制放大器的单个通道记录。每位患者术前填写 Spielberger 状态和特质焦虑量表的 Y-1 和 Y-2 表格，完成阿伯丁静脉曲张问卷，并在数字量表上评定焦虑水平。术后，患者在数字疼痛强度量表上填写他们在手术过程中感到的疼痛。MATLAB 软件（MathWorks，Natick，Mass）用于提取 R 波并生成 HRV 信号，并创建数学模型来预测每位患者的疼痛评分。
在多变量分析中，我们研究了报告的患者疼痛评分（rPPS）与阿伯丁静脉曲张问卷评分、术前 Y-1 和 Y-2 表格、术前焦虑水平和预测的患者疼痛评分（pPPS）之间的相关性。多变量分析发现 rPPS 与 pPPS 之间仅存在相关性。pPPS 与 rPPS 显著相关（R=0.807；P<.001），线性回归模型的 R 计算出预测准确率为 65.2%。
这项初步研究表明，术前 HRV 可以准确预测患者的疼痛，允许预测评分较高的患者在全身麻醉下进行手术。
