Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Rm7-405, 600 University Avenue, Toronto, ON, Canada.
Can J Anaesth. 2021 Dec;68(12):1802-1810. doi: 10.1007/s12630-021-02105-z. Epub 2021 Sep 28.
Approximately one in five women will experience severe postoperative pain after Cesarean delivery (CD). Previously, a bedside three-item questionnaire (3-IQ) has shown to predict women experiencing higher evoked pain intensity after CD, with an area under the receiver operator characteristics (ROC) curve of 0.72. We hypothesized that the addition of psychophysical pain tests to the existing 3-IQ would improve the ability to predict severe pain in women undergoing elective CD under spinal anesthesia METHODS: This was a prospective cohort study on women undergoing elective CD under spinal anesthesia. Women were assessed preoperatively using the 3-IQ, pressure algometry (PA) and mechanical temporal summation (TS) response. All women received standard perioperative care, including a multimodal analgesia regimen that included intrathecal fentanyl and morphine. A 0-100 mm visual analogue scale (VAS) was used to assess the severity of pain at rest (VASr) and on movement (VASm) at 24 and 48 hr after surgery. Patient satisfaction and opioid consumption were also recorded. We performed ROC curve analyses to assess whether we could improve the ability to predict our primary outcome of severe pain on movement at 24 hr (VASm24 ≥ 70).
We studied 195 women. Median [interquartile range] VASm24 was 53 [32-72] and 28% of patients experienced a VASm24 ≥ 70. The ability to predict a VASm24 ≥ 70 assessed by the area under the ROC curve was 0.64 using the 3-IQ and 0.67 using the 3-IQ combined with TS and PA.
The addition of PA and TS to the 3-IQ model resulted in a predictive model that performed similarly to the 3-IQ model alone. Further research is warranted in this area to better predict women at risk of severe pain post CD.
大约五分之一的女性在剖宫产（CD）后会经历严重的术后疼痛。此前，一项床边三项目问卷（3-IQ）已显示可预测经历 CD 后诱发疼痛强度更高的女性，其接受者操作特征（ROC）曲线下面积为 0.72。我们假设在现有的 3-IQ 中添加心理物理疼痛测试将提高预测接受脊髓麻醉下选择性 CD 的女性严重疼痛的能力。
这是一项对接受脊髓麻醉下选择性 CD 的女性进行的前瞻性队列研究。女性在术前使用 3-IQ、压力测痛（PA）和机械时间总和（TS）反应进行评估。所有女性均接受标准围手术期护理，包括鞘内芬太尼和吗啡的多模式镇痛方案。使用 0-100mm 视觉模拟量表（VAS）评估术后 24 和 48 小时静息时（VASr）和运动时（VASm）的疼痛严重程度。还记录了患者满意度和阿片类药物消耗量。我们进行了 ROC 曲线分析，以评估我们是否能够提高预测术后 24 小时运动时严重疼痛的主要结局（VASm24≥70）的能力。
我们研究了 195 名女性。中位[四分位间距]VASm24 为 53[32-72]，28%的患者 VASm24≥70。ROC 曲线下面积评估的预测 VASm24≥70 的能力，使用 3-IQ 为 0.64，使用 3-IQ 联合 TS 和 PA 为 0.67。
在 3-IQ 模型中添加 PA 和 TS 后，预测模型的表现与单独使用 3-IQ 模型相似。在这一领域需要进一步研究，以更好地预测 CD 后发生严重疼痛的女性。
