From the Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.
the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
Anesthesiology. 2021 Oct 1;135(4):711-723. doi: 10.1097/ALN.0000000000003951.
The purpose of this study was to determine the incidence, characteristics, impact, and risk factors associated with persistent incisional pain. The hypothesis was that patient demographics and perioperative interventions are associated with persistent pain.
This was a secondary analysis of an international prospective cohort study from 2012 to 2014. This study included patients who were 45 yr of age or older who underwent major inpatient noncardiac surgery. Data were collected perioperatively and at 1 yr after surgery to assess for the development of persistent incisional pain (pain present around incision at 1 yr after surgery).
Among 14,831 patients, 495 (3.3%; 95% CI, 3.1 to 3.6) reported persistent incisional pain at 1 yr, with an average pain intensity of 3.6 ± 2.5 (0 to 10 numeric rating scale), with 35% and 14% reporting moderate and severe pain intensities, respectively. More than half of patients with persistent pain reported needing analgesic medications, and 85% reported interference with daily activities (denominator = 495 in the above proportions). Risk factors for persistent pain included female sex (P = 0.007), Asian ethnicity (P < 0.001), surgery for fracture (P < 0.001), history of chronic pain (P < 0.001), coronary artery disease (P < 0.001), history of tobacco use (P = 0.048), postoperative patient-controlled analgesia (P < 0.001), postoperative continuous nerve block (P = 0.010), insulin initiation within 24 h of surgery (P < 0.001), and withholding nonsteroidal anti-inflammatory medication or cyclooxygenase-2 inhibitors on the day of surgery (P = 0.029 and P < 0.001, respectively). Older age (P < 0.001), endoscopic surgery (P = 0.005), and South Asian (P < 0.001), Native American/Australian (P = 0.004), and Latin/Hispanic ethnicities (P < 0.001) were associated with a lower risk of persistent pain.
Persistent incisional pain is a common complication of inpatient noncardiac surgery, occurring in approximately 1 in 30 adults. It results in significant morbidity, interferes with daily living, and is associated with persistent analgesic consumption. Certain demographics, ethnicities, and perioperative practices are associated with increased risk of persistent pain.
本研究旨在确定持续性切口疼痛的发生率、特征、影响和相关风险因素。我们的假设是，患者特征和围手术期干预与持续性疼痛相关。
这是一项 2012 年至 2014 年进行的国际前瞻性队列研究的二次分析。本研究纳入了年龄在 45 岁及以上、接受大型非心脏住院手术的患者。数据在围手术期和手术后 1 年采集，以评估持续性切口疼痛（术后 1 年时切口周围疼痛）的发生情况。
在 14831 名患者中，495 名（3.3%；95%CI，3.1%至 3.6%）在术后 1 年报告持续性切口疼痛，平均疼痛强度为 3.6±2.5（0 至 10 数字评分量表），35%和 14%分别报告中度和重度疼痛强度。超过一半的持续性疼痛患者需要使用镇痛药物，85%报告日常生活活动受到干扰（上述比例的分母为 495）。持续性疼痛的风险因素包括女性（P=0.007）、亚洲种族（P<0.001）、骨折手术（P<0.001）、慢性疼痛史（P<0.001）、冠状动脉疾病（P<0.001）、吸烟史（P=0.048）、术后患者自控镇痛（P<0.001）、术后连续神经阻滞（P=0.010）、手术 24 小时内开始使用胰岛素（P<0.001）和手术当天不使用非甾体抗炎药或环氧化酶-2 抑制剂（P=0.029 和 P<0.001）。年龄较大（P<0.001）、内镜手术（P=0.005）、南亚（P<0.001）、北美原住民/澳大利亚原住民（P=0.004）和拉丁裔/西班牙裔（P<0.001）与持续性疼痛的风险降低相关。
持续性切口疼痛是住院非心脏手术后的一种常见并发症，约 1/30 成年人会发生。它会导致明显的发病率，干扰日常生活，并与持续性镇痛药物的使用相关。某些人口统计学、种族和围手术期实践与持续性疼痛的风险增加相关。
