Anesthesiology. 2021 Mar 1;134(3):421-434. doi: 10.1097/ALN.0000000000003681.
The primary goal of this study was to evaluate patterns in acute postoperative pain in a mixed surgical patient cohort with the hypothesis that there would be heterogeneity in these patterns.
This study included 360 patients from a mixed surgical cohort whose pain was measured across postoperative days 1 through 7. Pain was characterized using the Brief Pain Inventory. Primary analysis used group-based trajectory modeling to estimate trajectories/patterns of postoperative pain. Secondary analysis examined associations between sociodemographic, clinical, and behavioral patient factors and pain trajectories.
Five distinct postoperative pain trajectories were identified. Many patients (167 of 360, 46%) were in the moderate-to-high pain group, followed by the moderate-to-low (88 of 360, 24%), high (58 of 360, 17%), low (25 of 360, 7%), and decreasing (21 of 360, 6%) pain groups. Lower age (odds ratio, 0.94; 95% CI, 0.91 to 0.99), female sex (odds ratio, 6.5; 95% CI, 1.49 to 15.6), higher anxiety (odds ratio, 1.08; 95% CI, 1.01 to 1.14), and more pain behaviors (odds ratio, 1.10; 95% CI, 1.02 to 1.18) were related to increased likelihood of being in the high pain trajectory in multivariable analysis. Preoperative and intraoperative opioids were not associated with postoperative pain trajectories. Pain trajectory group was, however, associated with postoperative opioid use (P < 0.001), with the high pain group (249.5 oral morphine milligram equivalents) requiring four times more opioids than the low pain group (60.0 oral morphine milligram equivalents).
There are multiple distinct acute postoperative pain intensity trajectories, with 63% of patients reporting stable and sustained high or moderate-to-high pain over the first 7 days after surgery. These postoperative pain trajectories were predominantly defined by patient factors and not surgical factors.
本研究的主要目的是评估混合外科患者队列中急性术后疼痛的模式，假设这些模式存在异质性。
本研究纳入了 360 名混合外科队列患者，他们的疼痛在术后第 1 至 7 天进行了测量。疼痛采用Brief Pain Inventory 进行评估。主要分析采用基于群组的轨迹建模来估计术后疼痛的轨迹/模式。次要分析检查了社会人口统计学、临床和行为患者因素与疼痛轨迹之间的关联。
确定了五种不同的术后疼痛轨迹。许多患者（360 名中的 167 名，46%）处于中高强度疼痛组，其次是中低强度（360 名中的 88 名，24%）、高强度（360 名中的 58 名，17%）、低强度（360 名中的 25 名，7%）和逐渐减轻（360 名中的 21 名，6%）疼痛组。较低的年龄（优势比，0.94；95%置信区间，0.91 至 0.99）、女性（优势比，6.5；95%置信区间，1.49 至 15.6）、较高的焦虑（优势比，1.08；95%置信区间，1.01 至 1.14）和更多的疼痛行为（优势比，1.10；95%置信区间，1.02 至 1.18）与多变量分析中处于高强度疼痛轨迹的可能性增加相关。术前和术中阿片类药物与术后疼痛轨迹无关。然而，疼痛轨迹组与术后阿片类药物的使用相关（P<0.001），高强度疼痛组（249.5 口服吗啡毫克当量）比低强度疼痛组（60.0 口服吗啡毫克当量）需要多四倍的阿片类药物。
存在多种不同的急性术后疼痛强度轨迹，其中 63%的患者报告在手术后的前 7 天内持续存在稳定和较高或中高强度的疼痛。这些术后疼痛轨迹主要由患者因素而非手术因素决定。
