Tsai Hsin-Jung, Chang Wen-Kuei, Yen Fang-Yu, Lin Shih-Pin, Lin Tzu-Ping, Chang Kuang-Yi
Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 112201, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan.
J Pers Med. 2022 Feb 26;12(3):360. doi: 10.3390/jpm12030360.
Background: Renal cell carcinoma (RCC) is the most common neoplasm in kidneys, and surgical resection remains the mainstay treatment. Few studies have investigated how the postoperative pain changes over time and what has affected its trajectory. This study aimed to characterize the variations in postoperative pain over time and investigate associated factors after RCC surgery. Methods: This retrospective study was conducted in a single medical center in Taiwan, where maximal pain scores in a numeric rating scale were recorded daily in the first five postoperative days (PODs) after RCC surgery. Latent curve models were developed, using two latent variables, intercept and slope, which represented the baseline pain and rate of pain resolution. These models explain the variations in postoperative pain scores over time. A predictive model for postoperative pain trajectories was also constructed. Results: There were 861 patients with 3850 pain observations included in the analysis. Latent curve analysis identified that female patients and those with advanced cancer (stage III and IV) tended to have increased baseline pain scores (p = 0.028 and 0.012, respectively). Furthermore, patients over 60 years, without PCA use (both p < 0.001), and with more surgical blood loss (p = 0.001) tended to have slower pain resolution. The final predictive model fit the collected data acceptably (RMSEA = 0.06, CFI = 0.95). Conclusion: Latent curve analysis identified influential factors of acute pain trajectories after RCC surgery. This study may also help elucidate the complex relationships between the variations in pain intensity over time and their determinants, and guide personalized pain management after surgery for RCC.
肾细胞癌（RCC）是肾脏最常见的肿瘤，手术切除仍是主要治疗方法。很少有研究调查术后疼痛如何随时间变化以及哪些因素影响其变化轨迹。本研究旨在描述RCC手术后疼痛随时间的变化特征，并调查相关因素。方法：本回顾性研究在台湾的一个医疗中心进行，记录了RCC手术后前五天（PODs）每天的数字评分量表最大疼痛评分。开发了潜在曲线模型，使用两个潜在变量，即截距和斜率，分别代表基线疼痛和疼痛缓解率。这些模型解释了术后疼痛评分随时间的变化。还构建了术后疼痛轨迹的预测模型。结果：分析纳入了861例患者，共3850次疼痛观察。潜在曲线分析确定，女性患者和晚期癌症（III期和IV期）患者的基线疼痛评分往往更高（分别为p = 0.028和0.012）。此外，60岁以上、未使用PCA（均p < 0.001）以及手术失血量更多（p = 0.001）的患者疼痛缓解往往较慢。最终的预测模型对收集的数据拟合良好（RMSEA = 0.06，CFI = 0.95）。结论：潜在曲线分析确定了RCC手术后急性疼痛轨迹的影响因素。本研究也可能有助于阐明疼痛强度随时间变化及其决定因素之间的复杂关系，并指导RCC手术后的个性化疼痛管理。
