Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
Department of Anesthesiology, Duke University School of Medicine, Durham, NC.
Clin J Pain. 2021 Jul 1;37(7):487-493. doi: 10.1097/AJP.0000000000000942.
Despite substantial research showing the bidrectional relationship between sleep and pain, there remains a dearth of research examining the role of perioperative pain management interventions in mitigating postoperative sleep disturbances. This secondary analysis of a prospective observational multisite study examined the association between peripheral nerve block (PNB) use during total knee or total hip arthroplasty (TKA/THA) procedures and postoperative pain and sleep outcomes.
Adult patients undergoing TKA or THA procedures were recruited from 2 tertiary care facilities. Average pain and sleep disturbance scores were collected preoperatively and at 1- and 2-week postoperatively. Participants were not randomized to receive PNB. Postoperative outcomes were compared based on receipt of PNB during surgery. Structural equation modeling path analysis was utilized to model multiple co-occurring relationships, including mediation pathways between perioperative pain management approaches, pain, and postoperative sleep outcomes.
Of the 197 participants, 53% received PNB. Mediation analyses indicated that PNB was indirectly associated with 1-week sleep disturbance via its effects on 1-week pain intensity (β=-0.02, 95% confidence interval [CI] -0.04, -0.001, P=0.04). In addition, PNB was indirectly associated with 2-week sleep disturbance, via its effects on 1-week pain intensity and 1-week sleep disturbance (β=-0.04, 95% CI -0.07, -0.02, P=0.04). Lastly, PNB was indirectly associated with 2-week pain intensity via its effects on 1-week pain intensity (β=-0.10, 95% CI -0.19, -0.02, P=0.02).
Receipt of PNB during TKA or THA was found to be associated with improved 1-week postoperative pain intensity, which in turn was found to be associated with lower sleep disturbances at both 1- and 2-week postoperative time points. Multimodal opioid sparing pain management interventions, capable of improving postoperative sleep, are vital to improving recovery and rehabilitation following arthroplasty.
尽管大量研究表明睡眠和疼痛之间存在双向关系，但仍缺乏研究来检验围手术期疼痛管理干预措施在减轻术后睡眠障碍方面的作用。这项前瞻性观察性多中心研究的二次分析检查了全膝关节或全髋关节置换术（TKA/THA）过程中使用外周神经阻滞（PNB）与术后疼痛和睡眠结果之间的关联。
从 2 家三级保健机构招募接受 TKA 或 THA 手术的成年患者。在术前和术后 1 周和 2 周收集平均疼痛和睡眠障碍评分。参与者未随机接受 PNB。根据手术期间是否接受 PNB 比较术后结果。结构方程模型路径分析用于建模多个同时发生的关系，包括围手术期疼痛管理方法、疼痛和术后睡眠结果之间的中介途径。
在 197 名参与者中，53%接受了 PNB。中介分析表明，PNB 通过对 1 周疼痛强度的影响，与 1 周睡眠障碍间接相关（β=-0.02，95%置信区间 [CI] -0.04，-0.001，P=0.04）。此外，PNB 通过对 1 周疼痛强度和 1 周睡眠障碍的影响，与 2 周睡眠障碍间接相关（β=-0.04，95%CI -0.07，-0.02，P=0.04）。最后，PNB 通过对 1 周疼痛强度的影响，与 2 周疼痛强度间接相关（β=-0.10，95%CI -0.19，-0.02，P=0.02）。
在 TKA 或 THA 期间接受 PNB 与术后 1 周时疼痛强度改善相关，而术后 1 周和 2 周时的睡眠障碍程度降低也与接受 PNB 相关。能够改善术后睡眠的多模式阿片类药物节省疼痛管理干预措施对于改善关节置换术后的恢复和康复至关重要。
