Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, Anhui, China.
BMC Anesthesiol. 2022 Apr 29;22(1):129. doi: 10.1186/s12871-022-01674-w.
Pre-existing chronic pain has been associated with severe postoperative pain. In this study, we sought to prospectively analyse the association between the duration of chronic low back pain and the intensity of acute postoperative pain after lumbar fusion surgery.
A total of 330 patients who underwent lumbar fusion surgery were divided into three groups (chronic low back pain less than 1 year, one to 5 years, and more than 5 years) based on the duration of chronic pain. On the first postoperative day, the maximum pain scores of each patient were recorded during the day and at night. Bivariate correlation and logistic regression were performed to identify relationships between acute postoperative pain and related variables (age, sex, smoking history, body mass index, operation history, duration of surgery, level of preoperative pain, aetiology of back pain, Self-rating Anxiety Scale, Self-rating Depression Scale, FRAIL scale, and duration of chronic low back pain). If the postoperative pain score was > 3 when the patient reported was at rest, the patients were treated with postoperative intravenous self-controlled analgesia or rescue analgesics if necessary.
There was an association between severe acute postoperative pain and the duration of chronic low back pain. In terms of VAS day, multivariable logistic regression showed the duration of chronic low back pain was not statistically significant (OR = 2.48, 95% CI: 0.900 to 6.828, p = 0.0789). The result is uncertain because the confidence interval included the null after controlling for SAS, SDS, BMI, and aetiology of back pain. In terms of VAS night, patients with a duration of chronic low back pain of more than 5 years were more likely having moderate to severe acute postoperative pain (VAS > 3) compared to patients with a duration of chronic low back pain less than 1 year (OR = 3.546, 95% CI: 1.405 to 8.95, p = 0.0074). Hospital stay, the pain score on the day of discharge and the pain score after 3 months displayed no significant difference among the three groups (P > 0.05). However, the need for postoperative rescue analgesics was different among the three groups (P < 0.05).
The longer the duration of chronic pain was, the higher the incidence of moderate to severe acute postoperative pain was and the greater the amount of analgesics required after surgery.
This study was registered at the Chinese Clinical Trial Registration Center ( http://www.chictr.org.cn/index.aspx , clinical trial number: ChiECRCT20200165, date of registration: July 6, 2020).
先前存在的慢性疼痛与严重的术后疼痛有关。在这项研究中，我们旨在前瞻性分析慢性腰痛持续时间与腰椎融合术后急性术后疼痛强度之间的关系。
根据慢性疼痛持续时间，将 330 名接受腰椎融合手术的患者分为三组（慢性腰痛小于 1 年、1-5 年和超过 5 年）。在术后第一天，记录每位患者白天和夜间的最大疼痛评分。采用双变量相关和逻辑回归分析急性术后疼痛与相关变量（年龄、性别、吸烟史、体重指数、手术史、手术持续时间、术前疼痛水平、背痛病因、焦虑自评量表、抑郁自评量表、脆弱性评估量表和慢性腰痛持续时间）之间的关系。如果患者在休息时报告的术后疼痛评分>3，则根据需要使用术后静脉自控镇痛或补救性镇痛。
严重的急性术后疼痛与慢性腰痛的持续时间有关。在 VAS 天方面，多变量逻辑回归显示慢性腰痛持续时间无统计学意义（OR=2.48，95%CI：0.900 至 6.828，p=0.0789）。在控制 SAS、SDS、BMI 和背痛病因后，置信区间包括了零值，结果不确定。在 VAS 夜间方面，慢性腰痛持续时间超过 5 年的患者比慢性腰痛持续时间小于 1 年的患者更有可能出现中度至重度急性术后疼痛（VAS>3）（OR=3.546，95%CI：1.405 至 8.95，p=0.0074）。三组患者的住院时间、出院当天的疼痛评分和 3 个月后的疼痛评分无显著差异（P>0.05）。然而，三组患者术后需要补救性镇痛的情况不同（P<0.05）。
慢性疼痛持续时间越长，急性术后中重度疼痛的发生率越高，术后所需的镇痛药物也越多。
本研究在中国临床试验注册中心注册（http://www.chictr.org.cn/index.aspx，临床试验编号：ChiECRCT20200165，注册日期：2020 年 7 月 6 日）。
