Liu Yue, Zhou Mingqin, Zhu Xuewen, Gu Xiaoping, Ma Zhengliang, Zhang Wei
Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.
J Anesth. 2020 Jun;34(3):330-337. doi: 10.1007/s00540-020-02743-5. Epub 2020 Feb 3.
A large proportion of patients experience chronic post-surgical pain (CPSP) following inguinal hernia repair surgery. The aim of this study was to investigate the predictive risk factors and protective factors for CPSP following inguinal hernia surgery.
After institutional ethics approval was obtained, we conducted a retrospective observational case-control study including a total of 236 adult patients undergoing elective inguinal hernia repair at a single tertiary medical center from 2014 to 2015. Preoperative and postoperative variables were collected from electronic medical records. Binary logistic analysis was used to determine the association between CPSP and clinical factors and built a CPSP risk model.
The incidence of CPSP was 14.4%. Bilateral inguinal hernia repair (OR 4.44; 95% CI 1.62 to 12.17; p = 0.004), preoperative pain (OR 2.57; 95% CI 1.14 to 5.79; p = 0.023), preoperative anxiety (OR 1.05; 95% CI 1.01 to 1.09; p = 0.018), and relatively high intensity of acute pain at 1 week after the surgery (OR 1.40; 95% CI 1.03 to 1.91; p = 0.031) were the risk factors for CPSP while low-dose ketamine at anesthesia induction (OR 0.42; 95% CI 0.18 to 0.98; p = 0.044) was the protective factor for CPSP in patients undergoing inguinal hernia repair.
These results indicated that bilateral inguinal hernia repair, preoperative pain, preoperative anxiety, and acute pain at 1 week after the surgery were the independent risk factors for CPSP while low-dose ketamine was the protective factor. These findings may assist with primary prevention by allowing clinicians to screen for individuals with the risk of CPSP.
很大一部分患者在腹股沟疝修补术后会经历慢性术后疼痛（CPSP）。本研究的目的是调查腹股沟疝手术后CPSP的预测风险因素和保护因素。
在获得机构伦理批准后，我们进行了一项回顾性观察性病例对照研究，共纳入2014年至2015年在一家三级医疗中心接受择期腹股沟疝修补术的236例成年患者。术前和术后变量从电子病历中收集。采用二元逻辑分析确定CPSP与临床因素之间的关联，并建立CPSP风险模型。
CPSP的发生率为14.4%。双侧腹股沟疝修补术（比值比[OR]4.44；95%置信区间[CI]1.62至12.17；p = 0.004）、术前疼痛（OR 2.57；95%CI 1.14至5.79；p = 0.023）、术前焦虑（OR 1.05；95%CI 1.01至1.09；p = 0.018）以及术后1周时相对较高强度的急性疼痛（OR 1.40；95%CI 1.03至1.91；p = 0.031）是CPSP的风险因素，而麻醉诱导时使用低剂量氯胺酮（OR 0.42；95%CI 0.18至0.98；p = 0.044）是腹股沟疝修补术患者CPSP的保护因素。
这些结果表明，双侧腹股沟疝修补术、术前疼痛、术前焦虑以及术后1周时的急性疼痛是CPSP的独立风险因素，而低剂量氯胺酮是保护因素。这些发现可能有助于通过让临床医生筛查有CPSP风险的个体来进行一级预防。
