University of Malaya, Faculty of Medicine, Department of Orthopaedic Surgery (NOCERAL), Kuala Lumpur, Malaysia.
University of Malaya, Faculty of Medicine, Department of Anaesthesiology, Kuala Lumpur, Malaysia.
Med J Malaysia. 2020 Jan;75(1):12-17.
This study looked into the different anatomical locations of pain and their trajectories within the first two weeks after Posterior Spinal Fusion (PSF) surgery for Adolescent Idiopathic Scoliosis (AIS).
We prospectively recruited patients with Adolescent Idiopathic Scoliosis (AIS) scheduled for PSF surgery. The anatomical locations of pain were divided into four: (1) surgical wound pain; (2) shoulder pain; (3) neck pain; and (4) low back pain. The anatomical locations of pain were charted using the visual analogue pain score at intervals of 12, 24, 36, 48 hours; and from day-3 to -14. Patient-controlled analgesia (morphine), use of celecoxib capsules, acetaminophen tablets and oxycodone hydrochloride capsule consumption were recorded.
A total of 40 patients were recruited. Patients complained of surgical wound pain score of 6.2±2.1 after surgery. This subsequently reduced to 4.2±2.0 by day-4, and to 2.4±1.3 by day-7. Shoulder pain scores of symptomatic patients peaked to 4.2±2.7 at 24 hours and 36 hours which then reduced to 1.8±1.1 by day-8. Neck pain scores of symptomatic patients reduced from 4.2±1.9 at 12 hours to 1.8±1.1 by day-4. Low back pain scores of symptomatic patients reduced from 5.3±2.3 at 12 hours to 1.8±1.1 by day- 12.
Despite the presence of different anatomical locations of pain after surgery, surgical wound was the most significant pain and other anatomical locations of pain were generally mild. Surgical wound pain reduced to a tolerable level by day-4 when patients can then be comfortably discharged. This finding provides useful information for clinicians, patients and their caregivers.
本研究探讨了青少年特发性脊柱侧凸(AIS)后路脊柱融合(PSF)术后前两周疼痛的不同解剖部位及其轨迹。
我们前瞻性招募了计划接受 PSF 手术的 AIS 患者。疼痛的解剖部位分为 4 个:(1)手术切口疼痛;(2)肩部疼痛;(3)颈部疼痛;(4)下腰痛。使用视觉模拟评分法(VAS)在 12、24、36、48 小时和术后第 3 天至第 14 天记录疼痛的解剖部位。记录患者自控镇痛(吗啡)、塞来昔布胶囊、对乙酰氨基酚片和盐酸羟考酮胶囊的使用情况。
共招募了 40 名患者。术后患者诉手术切口疼痛评分 6.2±2.1。第 4 天降至 4.2±2.0,第 7 天降至 2.4±1.3。有症状患者的肩部疼痛评分在术后 24 和 36 小时达到峰值 4.2±2.7,第 8 天降至 1.8±1.1。有症状患者的颈部疼痛评分在术后 12 小时从 4.2±1.9降至第 4 天的 1.8±1.1。有症状患者的下腰痛评分在术后 12 小时从 5.3±2.3降至第 12 天的 1.8±1.1。
尽管术后存在不同的解剖部位疼痛,但手术切口是最显著的疼痛,其他解剖部位的疼痛通常较轻。术后第 4 天,手术切口疼痛可降至可耐受水平,患者可舒适出院。这一发现为临床医生、患者及其护理人员提供了有用的信息。