González-Callejas Cristina, Aparicio Virginia A, De Teresa Carlos, Nestares Teresa
General Surgery Department, San Cecilio University Hospital, Granada, Spain.
Department of Physiology, Institute of Nutrition and Food Technology, Biomedical Research Centre, University of Granada, Granada, Spain.
Pain Med. 2020 Aug 1;21(8):1636-1643. doi: 10.1093/pm/pnz325.
i) To analyze the association of body mass index (BMI) and some serum tissue damage markers with postoperative pain. ii) To establish a biochemical marker cutoff point able to predict moderate to severe postoperative pain.
Cross-sectional study.
Ninety-six adult male patients from Southern Spain (55 ± 13 years old) who underwent an inguinal hernioplasty.
Postoperative pain (eight hours after surgery) was assessed through a visual analog scale (VAS). Moderate to severe pain was defined as a VAS > 50 mm. BMI was calculated and medication, alcohol consumption, and smoking habit registered. Eight hours after surgery, some serum markers such as fibrinogen, lactate dehydrogenase (LDH), C-reactive protein, cortisol, creatine kinase, glutamic-pyruvic, glutamic oxaloacetic, and gamma-glutamyltransferase transaminases were determined by standard procedures.
After adjusting for potential confounders, BMI was not associated with postoperative pain (P > 0.05). Serum fibrinogen was associated with greater postoperative pain (β = 0.333, P < 0.05). Serum LDH concentration was strongly associated with greater postoperative pain (β = 0.606, P < 0.001). Alcohol consumption was associated with higher postoperative pain (β = 0.212, P < 0.05). No associations were observed regarding age, tobacco consumption, and the rest of serum markers studied. Serum LDH concentration was able to discriminate between presence/absence of moderate to severe postoperative pain (receiver operating characteristic area under the curve = 0.655, P ≤ 0.01). An LDH concentration >204 IU/L was associated with a three-times increased odds ratio of moderate to severe postoperative pain.
Contrary to expectations, greater BMI was not associated with higher postoperative pain. Notwithstanding, the assessment of serum LDH might provide useful information to predict moderate to severe postoperative pain.
i）分析体重指数（BMI）和一些血清组织损伤标志物与术后疼痛的关联。ii）确定一个能够预测中度至重度术后疼痛的生化标志物临界值。
横断面研究。
来自西班牙南部的96名成年男性患者（55±13岁），他们接受了腹股沟疝修补术。
通过视觉模拟量表（VAS）评估术后疼痛（术后8小时）。中度至重度疼痛定义为VAS>50mm。计算BMI，并记录用药情况、饮酒量和吸烟习惯。术后8小时，通过标准程序测定一些血清标志物，如纤维蛋白原、乳酸脱氢酶（LDH）、C反应蛋白、皮质醇、肌酸激酶、谷丙转氨酶、谷草转氨酶和γ-谷氨酰转移酶。
在对潜在混杂因素进行调整后，BMI与术后疼痛无关（P>0.05）。血清纤维蛋白原与术后疼痛加剧有关（β=0.333，P<0.05）。血清LDH浓度与术后疼痛加剧密切相关（β=0.606，P<0.001）。饮酒与术后疼痛加剧有关（β=0.212，P<0.05）。未观察到年龄、吸烟与所研究其他血清标志物之间存在关联。血清LDH浓度能够区分是否存在中度至重度术后疼痛（曲线下面积=0.655，P≤0.01）。LDH浓度>204IU/L与中度至重度术后疼痛的比值比增加三倍有关。
与预期相反，较高的BMI与较高的术后疼痛无关。尽管如此，血清LDH的评估可能为预测中度至重度术后疼痛提供有用信息。
