Department of Anaesthesia and Pain Management and Royal Melbourne Hospital, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Department of Anaesthesia and Pain Management and Royal Melbourne Hospital, Melbourne, Australia; Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia.
Br J Anaesth. 2019 Sep;123(3):350-359. doi: 10.1016/j.bja.2019.05.030. Epub 2019 Jun 24.
We conducted a cohort study of adult patients presenting for orthopaedic trauma surgery at a statewide trauma centre, with the aims of determining (i) the incidence and risk factors for severe acute pain in the PACU, and (ii) the incidence and risk factors for persistent post-surgical pain at 3 months.
Data were collected before operation, in the PACU, 72 h after surgery and 3 months after surgery, and included numerical rating scale (NRS) scores for pain, and modified Brief Pain Inventory-Short Form, Kessler Psychological Distress Scale, World Health Organization Disability Assessment Schedule, and Pain Catastrophizing Scale scores.
Severe acute pain in the PACU was reported by 171 (56%; 95% confidence interval [CI]: 51%, 62%) of the 303 included patients. Female sex (odds ratio [OR]: 1.86; 95% CI: 1.06, 3.26) and prior post-injury surgery (OR: 2.21; 95% CI: 1.11, 4.41) remained associated with severe acute pain after multivariable adjustment. Persistent post-surgical pain at 3 months was reported by 149 (65%; 95% CI: 59%, 71%) of the 229 included patients. The preoperative NRS score (OR: 1.17; 95% CI: 1.03, 1.32) remained associated with persistent pain after multivariable adjustment.
We identified three easy-to-measure risk factors: female sex, prior post-injury surgery for severe acute pain, and preoperative NRS scores for persistent pain. Further research is required to identify pain management strategies and psychosocial interventions to reduce the burden of pain, disability, and distress in these patients.
我们对全州创伤中心接受骨科创伤手术的成年患者进行了队列研究，目的是确定（i）PACU 中严重急性疼痛的发生率和危险因素，以及（ii）3 个月时持续性手术后疼痛的发生率和危险因素。
数据在术前、PACU 中、手术后 72 小时和手术后 3 个月收集，包括疼痛的数字评分量表（NRS）评分以及改良的简短疼痛清单-短表、凯斯勒心理困扰量表、世界卫生组织残疾评估量表和疼痛灾难化量表评分。
303 例纳入患者中，171 例（56%；95%置信区间[CI]：51%，62%）报告 PACU 中出现严重急性疼痛。女性（比值比[OR]：1.86；95%CI：1.06，3.26）和既往创伤后手术（OR：2.21；95%CI：1.11，4.41）在多变量调整后仍与严重急性疼痛相关。229 例纳入患者中，149 例（65%；95%CI：59%，71%）报告 3 个月时有持续性手术后疼痛。术前 NRS 评分（OR：1.17；95%CI：1.03，1.32）在多变量调整后仍与持续性疼痛相关。
我们确定了三个易于测量的危险因素：女性、既往创伤后手术与严重急性疼痛相关，以及术前 NRS 评分与持续性疼痛相关。需要进一步研究以确定疼痛管理策略和心理社会干预措施，以减轻这些患者的疼痛、残疾和痛苦负担。
