Vaughns Janelle D, Williams Elaine F, Mackey Eleanor R, Muret Jane C, van den Anker John, Nadler Evan P, Quezado Zenaide M
Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Health System/The George Washington University School of Medicine and Health Sciences, Washington, DC., Washington, DC, USA.
Division of Pediatric Clinical Pharmacology, Children's National Health System/The George Washington University School of Medicine and Health Sciences, Washington, DC., Washington, DC, USA.
Obes Surg. 2019 May;29(5):1557-1562. doi: 10.1007/s11695-019-03727-5.
To examine the impact of preexisting psychiatric/psychological diagnoses on perioperative analgesic requirements in adolescents with morbid obesity undergoing bariatric surgery.
A retrospective cohort study of adolescents with morbid obesity undergoing bariatric surgery. Primary and secondary outcomes included perioperative analgesic intake and pain scores (Numerical Rating Scale (0-10) NRS) throughout the hospital stay.
From our Bariatric Surgery Research Registry, we identified 17 adolescents with psychiatric/psychological diagnoses prior to undergoing bariatric surgery. Fifteen patients from the same registry and without such diagnosis undergoing bariatric surgery during the same time interval served as controls. In both groups, there was a predominance of female patients. During the perioperative period, in both groups, oral morphine equivalent and ketorolac and acetaminophen intake were similar. Notably, the perioperative median pain scores at the times examined were below 5 for all patients. The median pain scores in the PACU, day of surgery, and first postoperative day were similar. Conversely, on postoperative day 2, pain scores were higher in patients with diagnoses of psychiatric/psychological disorders (p = 0.004) compared to those without.
In this cohort of morbidly obese adolescents undergoing bariatric surgery, patients with and without preexisting psychiatric/psychological diagnoses had similar analgesic requirements during the perioperative period. This finding appears contrary to those suggesting that preexisting depression and/or anxiety might be associated with increased analgesic requirements during the perioperative period.
探讨既往精神/心理诊断对接受减肥手术的病态肥胖青少年围手术期镇痛需求的影响。
对接受减肥手术的病态肥胖青少年进行一项回顾性队列研究。主要和次要结局包括整个住院期间的围手术期镇痛药物摄入量和疼痛评分（数字评分量表（0 - 10），NRS）。
从我们的减肥手术研究登记处，我们识别出17名在接受减肥手术前有精神/心理诊断的青少年。来自同一登记处的15名在同一时间间隔内接受减肥手术且无此类诊断的患者作为对照。两组中女性患者均占多数。在围手术期，两组的口服吗啡等效剂量、酮咯酸和对乙酰氨基酚摄入量相似。值得注意的是，在所有检查时间点，所有患者的围手术期疼痛评分中位数均低于5分。麻醉后监护病房（PACU）、手术日和术后第一天的疼痛评分中位数相似。相反，在术后第2天，有精神/心理障碍诊断的患者疼痛评分高于无此类诊断的患者（p = 0.004）。
在这组接受减肥手术的病态肥胖青少年中，有和没有既往精神/心理诊断的患者在围手术期的镇痛需求相似。这一发现似乎与那些表明既往抑郁和/或焦虑可能与围手术期镇痛需求增加相关的研究结果相反。
