Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Acta Chir Belg. 2022 Oct;122(5):303-311. doi: 10.1080/00015458.2021.1881336. Epub 2022 Jul 18.
Adhesions are the most common cause of chronic abdominal pain after surgery. Surgical adhesiolysis can relieve symptoms in selected patients, but many require other treatments. The aim of this study is to evaluate analgesic treatments other than abdominal surgery in chronic pain related to adhesions.
A search was conducted in PubMed, Embase, and Central. Studies with patients suffering from chronic postoperative pain related to adhesions and undergoing all types' analgesic treatment were included. The primary outcome was the number of patients who improved in pain at long-term follow-up (at least 1 year). Secondary outcomes included improvement in pain at 3 months follow-up, quality of life, and physical functioning.
Searches identified 3022 citations. Four studies were included, one trial, one cohort study, and two case reports. The primary outcome was not reported. In a small trial ( = 18) pregabalin tended to have a benefit over placebo improving pain at 3 months. In the cohort study, 17 patients with chronic pelvic pain underwent a trial of sacral nerve stimulation. Eight patients who responded positively received an implanted device for continuous modulation, reporting sustainable improvement during follow-up (range: 6-36 months). One case report described improved pain at 6 months with trans-abdominis plane stimulation. The second report described improvement of physical function with manual therapy at long-term follow-up.
Low level of evidence is available regarding analgesic treatments of chronic abdominal and pelvic pain related to adhesions. The benefit of pregabalin is doubtful; nerve modulation is promising in a selected group.HighlightsAdhesions are a frequent cause of chronic abdominal and pelvic pain after surgery.Many patients are not good candidates for surgery (Adhesiolysis) or have relapses of pain.There is an important knowledge gap regarding non-surgical analgesic treatment.Analgesia in adhesion-related chronic abdominal pain after surgery.
粘连是腹部手术后慢性腹痛的最常见原因。在选择的患者中，手术粘连松解术可以缓解症状，但许多患者需要其他治疗。本研究旨在评估除腹部手术以外的其他镇痛治疗方法对粘连相关慢性疼痛的疗效。
在 PubMed、Embase 和 Central 数据库中进行了检索。纳入了患有慢性术后粘连相关疼痛并接受各种镇痛治疗的患者的研究。主要结局是在长期随访（至少 1 年）中疼痛改善的患者人数。次要结局包括 3 个月随访时疼痛改善、生活质量和身体功能。
检索到 3022 条参考文献。纳入了 4 项研究，其中 1 项为试验，1 项为队列研究，2 项为病例报告。主要结局未报道。在一项小型试验（n=18）中，普瑞巴林在 3 个月时改善疼痛的效果优于安慰剂。在队列研究中，17 例慢性盆腔痛患者接受了骶神经刺激试验。8 例对治疗有积极反应的患者接受了植入式连续调节设备，在随访期间（6-36 个月）报告了可持续的改善。1 例病例报告描述了经腹平面刺激后 6 个月时疼痛得到改善。第二份报告描述了长期随访时手动治疗对身体功能的改善。
粘连相关慢性腹部和盆腔疼痛的镇痛治疗的证据水平较低。普瑞巴林的疗效值得怀疑；神经调节在特定患者群体中具有很大的应用前景。
粘连相关慢性腹部和盆腔疼痛的镇痛治疗。
