乳腺癌手术后严重急性疼痛和持续性疼痛的危险因素：一项前瞻性观察研究。
Risk factors for severe acute pain and persistent pain after surgery for breast cancer: a prospective observational study.
机构信息
Department of Anesthesiology, Duke University, Durham, North Carolina, USA
Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee, USA.
出版信息
Reg Anesth Pain Med. 2019 Feb;44(2):192-199. doi: 10.1136/rapm-2018-000040. Epub 2019 Jan 5.
BACKGROUND AND OBJECTIVES
There are few prospective studies providing comprehensive assessment of risk factors for acute and persistent pain after breast surgery. This prospective observational study assessed patient-related, perioperative, and genetic risk factors for severe acute pain and persistent pain following breast cancer surgery.
METHODS
Women presenting for elective breast cancer surgery completed State Trait Anxiety Inventory, Beck Depression Inventory, and Pain Catastrophizing Scale questionnaires preoperatively. Diffuse noxious inhibitory control and mechanical temporal summation were assessed. A blood sample was obtained for genetic analysis. Analgesic consumption and pain scores were collected in the post-anesthesia care unit, and at 24 and 72 hours. Patients were contacted at 1, 3, 6, and 12 months to assess persistent pain. Primary outcome was maximum acute pain score in first 72 hours and secondary outcome was persistent pain.
RESULTS
One hundred twenty-four patients were included in analysis. Increased duration of surgery, surgeon, and higher pain catastrophizing scores were associated with increased severity of acute pain, while preoperative radiotherapy was associated with reduced severity. Persistent pain was reported by 57.3% of patients. Postdischarge chemotherapy (OR 2.52, 95% CI 1.13 to 5.82), postdischarge radiation (OR 3.39, 95% CI 1.24 to 10.41), severe acute pain (OR 5.39, 95% CI 2.03 to 15.54), and moderate acute pain (OR 5.31, 95% CI 1.99 to 15.30) were associated with increased likelihood of persistent pain.
CONCLUSIONS
Increased duration of surgery, higher pain catastrophizing score, and surgeon were associated with increased severity of acute pain. Preoperative radiation was associated with lower acute pain scores. Postsurgery radiation, chemotherapy, and severity of acute pain were associated with increased likelihood of persistent pain.
TRIAL REGISTRATION
NCT03307525.
背景与目的
鲜有前瞻性研究全面评估乳腺癌手术后急性和持续性疼痛的危险因素。本前瞻性观察研究评估了与患者相关的、围手术期的和遗传风险因素，以预测乳腺癌手术后严重急性疼痛和持续性疼痛。
方法
择期行乳腺癌手术的女性患者在术前完成状态特质焦虑量表、贝克抑郁量表和疼痛灾难化量表问卷。评估弥散性伤害性抑制控制和机械时间总和。采集血样进行基因分析。在麻醉后恢复室、术后 24 小时和 72 小时收集镇痛药物消耗和疼痛评分。术后 1、3、6 和 12 个月时联系患者评估持续性疼痛。主要结局是前 72 小时内的最大急性疼痛评分，次要结局是持续性疼痛。
结果
共纳入 124 例患者进行分析。手术时间延长、手术医生不同和较高的疼痛灾难化评分与急性疼痛严重程度增加相关，而术前放疗与疼痛严重程度降低相关。57.3%的患者报告有持续性疼痛。出院后化疗（OR 2.52，95%CI 1.13 至 5.82）、出院后放疗（OR 3.39，95%CI 1.24 至 10.41）、严重急性疼痛（OR 5.39，95%CI 2.03 至 15.54）和中度急性疼痛（OR 5.31，95%CI 1.99 至 15.30）与持续性疼痛的可能性增加相关。
结论
手术时间延长、较高的疼痛灾难化评分和手术医生与急性疼痛严重程度增加相关。术前放疗与较低的急性疼痛评分相关。术后放疗、化疗和急性疼痛严重程度与持续性疼痛的可能性增加相关。
试验注册
NCT03307525。
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