Department of Anesthesiology, Saint-Luc University Hospital, Université catholique de Louvain (UCL), Brussels, Belgium.
Department of Anaesthesia and Intensive Care Medecine, University of Liege Hospital (ULg CHU), Liege, Belgium.
Acta Anaesthesiol Scand. 2019 Aug;63(7):931-938. doi: 10.1111/aas.13370. Epub 2019 Apr 9.
Enhanced recovery after surgery (ERAS) program improves immediate recovery. Beyond immediate benefits, long-term impact of ERAS implementation is not yet evident. This retrospective single-center cohort study investigates prevalence and characteristics of chronic post-surgical pain (CPSP) in patients who underwent colon surgery.
Two hundred and ninety-seven patients enrolled prospectively in our ERAS database were contacted by mail to question the presence of CPSP. In case of CPSP, intensity, location, and type of pain, impact of pain on quality of life and treatment taken were assessed. Post-operative pain experience during hospital stay, recall of pain, and discomfort duration when back home were assessed in all patients. Comparison between patients with and without CPSP was made to approach the risk factors of CPSP in this population.
At 27 months after colon surgery, 25/198 patients reported CPSP (12.6%) and pain was severe in 5 patients (2.5%). CPSP had a deep abdominal component in 56% of patients and a parietal component in 20% of patients. Patients with CPSP+ differed from patients CPSP- for pre-operative pain presence (56% vs 24.8%, P = 0.004), recalled post-operative pain intensity (4 vs 3, P = 0.045), duration of discomfort after discharge (2 vs 1 weeks, P = 0.035). Pre-operative pain was found as a significant CPSP risk factor (odds ratio 1.34; 95% CI: 1.05-1.70).
CPSP prevalence after laparoscopic colon surgery seems not much affected by ERAS context. Pre-operative presence of pain emerged as an important risk factor. These findings should be confirmed in a prospective multicenter study.
术后加速康复（ERAS）方案可促进患者的即时康复。除了即时获益外，ERAS 实施的长期影响尚不清楚。本回顾性单中心队列研究调查了接受结肠手术的患者中慢性术后疼痛（CPSP）的发生率和特征。
我们前瞻性地将 297 名患者纳入 ERAS 数据库，并通过邮件联系他们询问是否存在 CPSP。如果存在 CPSP，则评估疼痛的强度、位置和类型，疼痛对生活质量的影响以及所采取的治疗方法。所有患者均评估住院期间的术后疼痛体验、疼痛回忆和出院后不适持续时间。比较 CPSP 患者和无 CPSP 患者，以探讨该人群中 CPSP 的危险因素。
在结肠手术后 27 个月时，198 名患者中有 25 名（12.6%）报告存在 CPSP，其中 5 名（2.5%）疼痛剧烈。CPSP 患者中有 56%存在深部腹部疼痛，20%存在壁层疼痛。CPSP+患者与 CPSP-患者在术前疼痛存在（56%比 24.8%，P=0.004）、术后回忆的疼痛强度（4 比 3，P=0.045）、出院后不适持续时间（2 比 1 周，P=0.035）方面存在差异。术前疼痛是 CPSP 的显著危险因素（优势比 1.34；95%可信区间：1.05-1.70）。
腹腔镜结肠手术后 CPSP 的发生率似乎不受 ERAS 背景的影响。术前疼痛的存在是一个重要的危险因素。这些发现应在一项前瞻性多中心研究中得到证实。
