Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China.
BMC Anesthesiol. 2020 Apr 18;20(1):86. doi: 10.1186/s12871-020-01003-z.
Postoperative pain is the most prominent concern among surgical patients. It has previously been reported that venous cannulation-induced pain (VCP) can be used to predict postoperative pain after laparoscopic cholecystectomy within 90 mins in the recovery room. Its potential in predicting postoperative pain in patients with patient-controlled intravenous analgesia (PCIA) is worth establishing. The purpose of this prospective observational study was to investigate the application of VCP in predicting postoperative pain in patients with PCIA during the first 24 h after laparoscopic nephrectomy.
One hundred twenty patients scheduled for laparoscopic nephrectomy were included in this study. A superficial vein on the back of the hand was cannulated with a standard-size peripheral venous catheter (1.1 × 3.2 mm) by a nurse in the preoperative areas. Then the nurse recorded the VAS score associated with this procedure estimated by patients, and dichotomized the patients into low response group (VAS scores < 2.0) or high response group (VAS scores ≥2.0). After general anesthesia and surgery, all the patients received the patient-controlled intravenous analgesia (PCIA) with sufentanil. The VAS scores at rest and on coughing at 2 h, 4 h, 8 h, 12 h, 24 h, the effective number of presses and the number of needed rescue analgesia within 24 h after surgery were recorded.
Peripheral venous cannulation-induced pain score was significantly correlated with postoperative pain intensity at rest (r = 0.64) and during coughing (r = 0.65), effective times of pressing (r = 0.59), additional consumption of sufentanil (r = 0.58). Patients with venous cannulation-induced pain intensity ≥2.0 VAS units reported higher levels of postoperative pain intensity at rest (P < 0.0005) and during coughing (P < 0.0005), needed more effective times of pressing (P < 0.0005) and additional consumption of sufentanil (P < 0.0005), and also needed more rescue analgesia (P = 0.01) during the first 24 h. The odds of risk for moderate or severe postoperative pain (OR 3.5, 95% CI 1.3-9.3) was significantly higher in patients with venous cannulation-induced pain intensity ≥2.0 VAS units compared to those <2.0 VAS units.
Preoperative assessment of pain induced by venous cannulation can be used to predict postoperative pain intensity in patients with PCIA during the first 24 h after laparoscopic nephrectomy.
We registered this study in a Chinese Clinical Trial Registry (ChiCTR) center on July 6 2019 and received the registration number: ChiCTR1900024352.
术后疼痛是外科患者最关注的问题。先前有研究报道，静脉穿刺诱导的疼痛（VCP）可用于预测腹腔镜胆囊切除术后 90 分钟内恢复室患者的术后疼痛。其预测术后疼痛的潜在价值值得进一步研究。本前瞻性观察性研究旨在探讨 VCP 预测腹腔镜肾切除术后患者 PCIA 期间 24 小时内术后疼痛的应用。
本研究纳入了 120 例拟行腹腔镜肾切除术的患者。在术前区域，由护士在手背上的浅表静脉中插入标准尺寸的外周静脉导管（1.1×3.2mm）。然后，护士记录患者估计的与该操作相关的 VAS 评分，并将患者分为低反应组（VAS 评分＜2.0）或高反应组（VAS 评分≥2.0）。全麻和手术后，所有患者均接受舒芬太尼 PCIA。记录术后 2、4、8、12、24 小时静息和咳嗽时的 VAS 评分、按压有效次数和术后 24 小时内需要的解救性镇痛次数。
静脉穿刺诱导疼痛评分与术后静息时疼痛强度（r=0.64）和咳嗽时疼痛强度（r=0.65）、按压有效次数（r=0.59）和舒芬太尼的额外消耗量（r=0.58）均呈显著相关。静脉穿刺诱导疼痛强度≥2.0 VAS 单位的患者术后静息时（P＜0.0005）和咳嗽时（P＜0.0005）疼痛强度更高，需要更多的按压有效次数（P＜0.0005）和舒芬太尼的额外消耗量（P＜0.0005），且在术后 24 小时内需要更多的解救性镇痛（P=0.01）。与 VAS 评分＜2.0 的患者相比，静脉穿刺诱导疼痛强度≥2.0 VAS 单位的患者发生中度或重度术后疼痛的风险（OR 3.5，95%CI 1.3-9.3）显著更高。
术前评估静脉穿刺诱导的疼痛可以预测腹腔镜肾切除术后患者 PCIA 期间 24 小时内的术后疼痛强度。
我们于 2019 年 7 月 6 日在中国临床试验注册中心注册了这项研究，并获得了注册号：ChiCTR1900024352。
