Department of Anesthesiology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, Wuxi, 214125, Jiangsu, People's Republic of China.
Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China.
BMC Anesthesiol. 2021 Nov 13;21(1):281. doi: 10.1186/s12871-021-01505-4.
The association of psychological factors with postoperative pain has been well documented. The incorporation of psychoeducational intervention into a standard analgesia protocol seems to be an attractive approach for the management of acute postoperative pain. Our study aimed to evaluate the impact of psychoeducational intervention on acute postoperative pain in pulmonary nodule (PN) patients treated with thoracoscopic surgery.
In this study, 76 PN patients treated with thoracoscopic surgery and intravenous patient-controlled analgesia (IV-PCA) plus psychoeducational evaluation and intervention were selected as the psychoeducational intervention group (PG). Another 76 PN patients receiving IV-PCA without psychoeducational intervention after thoracoscopic surgery, treated as the control group (CG), were identified from the hospital database and matched pairwise with PG patients according to age, sex, preoperative body mass index (BMI), opioid medications used for IV-PCA and the educational attainment of patients.
The most common psychological disorders were anxiety and interpersonal sensitivity, which were recorded from 82.9% (63/76) and 63.2% (48/76) of PG patients. The numerical rating scale (NRS) pain scores of the PG patients were significantly lower than those of the CG patients at 2 and 24 h after surgery (P < 0.001). Total opioid consumption for acute postoperative pain in the PG was 52.1 mg of morphine equivalent, which was significantly lower than that (67.8 mg) in the CG (P = 0.038). PG patients had a significantly lower incidence of rescue analgesia than CG patients (28.9% vs. 44.7%, P = 0.044). Nausea/vomiting was the most common side effect of opioid medications, recorded for 3 (3.9%) PG patients and 10 (13.2%) CG patients (P = 0.042). In addition, no significant difference was observed between PG and CG patients in terms of grade 2 or higher postoperative complications (10.5% vs. 17.1%, P = 0.240).
Psychoeducational intervention for PN patients treated with thoracoscopic surgery resulted in reduced acute postoperative pain, less opioid consumption and fewer opioid-related side effects.
心理因素与术后疼痛之间的关联已有充分的文献记载。将心理教育干预纳入标准镇痛方案似乎是管理急性术后疼痛的一种有吸引力的方法。我们的研究旨在评估心理教育干预对接受胸腔镜手术治疗的肺结节 (PN) 患者急性术后疼痛的影响。
本研究中，选择 76 例接受胸腔镜手术和静脉患者自控镇痛 (IV-PCA) 加心理教育评估和干预的 PN 患者作为心理教育干预组 (PG)。从医院数据库中另选择 76 例接受胸腔镜手术后接受 IV-PCA 而无心理教育干预的 PN 患者作为对照组 (CG)，并根据年龄、性别、术前体重指数 (BMI)、用于 IV-PCA 的阿片类药物和患者的受教育程度与 PG 患者进行配对。
PG 患者最常见的心理障碍是焦虑和人际敏感，分别有 82.9%（63/76）和 63.2%（48/76）的患者存在。PG 患者术后 2 小时和 24 小时的数字评分量表 (NRS) 疼痛评分明显低于 CG 患者（P<0.001）。PG 患者急性术后疼痛的总阿片类药物消耗量为 52.1mg 吗啡当量，明显低于 CG 患者（67.8mg）（P=0.038）。PG 患者的解救性镇痛发生率明显低于 CG 患者（28.9% vs. 44.7%，P=0.044）。恶心/呕吐是阿片类药物最常见的副作用，PG 患者有 3 例（3.9%），CG 患者有 10 例（13.2%）（P=0.042）。此外，PG 和 CG 患者在 2 级或更高术后并发症方面无显著差异（10.5% vs. 17.1%，P=0.240）。
对接受胸腔镜手术治疗的 PN 患者进行心理教育干预可减轻急性术后疼痛，减少阿片类药物的消耗，并减少阿片类药物相关的副作用。
