Bakshi Sumitra, Rana Meenal, Gulia Ashish, Puri Ajay, Harsha Tadala Ss, Tiwari Shashank, Gotur Aparna
Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India.
Department of Cardiothoracic Anaesthesia, Glenfield Hospital, Leicester, UK.
Br J Pain. 2022 Jun;16(3):263-269. doi: 10.1177/20494637211047143. Epub 2021 Sep 27.
Hemipelvectomy is a major surgery most often performed for pelvic malignancy. These complex surgeries often involve dissection around major neurovascular bundle and resection of tumour being bone along with involved tissues. This may result in short and long term morbidities. There is very little literature about incidence of chronic pain after pelvic resections. We conducted a prospective study at a tertiary cancer hospital to assess the prevalence of chronic pain post hemipelvectomy.
This is a single centre prospective observational study conducted over 30 months. Pain scores were recorded using Brief pain inventory (BPI) and pain detect questionnaire. The quality of life was assessed using musculoskeletal tumour society (MSTS) score. Intra-operative details like extent of surgical resection, nerves spared, details of intra-operative and post-operative analgesia were retrieved from the patient files. Data were analysed using SPSS 21 version.
Neuropathic pain post hemipelvectomy was uncommon. The prevalence of mild to moderate somatic pain was around 30%. Functional limitation was minimal as assessed by BPI and MSTS score. A high incidence of numbness was seen to persist in and around the area of surgical incision (50%).
This is first study to report the incidence of chronic pain post hemipelvectomy done for pelvic tumour resections. Despite the extensive nature of resection involved, there is a low prevalence of neuropathic pain in this population. However, incidence of persistent somatic pain is high and there is a need for further studies for evaluating the causality.
半骨盆切除术是一种主要用于治疗骨盆恶性肿瘤的大型手术。这些复杂手术通常涉及围绕主要神经血管束进行解剖以及切除肿瘤所在的骨骼及相关组织。这可能导致短期和长期的并发症。关于骨盆切除术后慢性疼痛发生率的文献非常少。我们在一家三级癌症医院进行了一项前瞻性研究,以评估半骨盆切除术后慢性疼痛的患病率。
这是一项在30个月内进行的单中心前瞻性观察性研究。使用简明疼痛量表(BPI)和疼痛检测问卷记录疼痛评分。使用肌肉骨骼肿瘤学会(MSTS)评分评估生活质量。从患者病历中获取手术切除范围、保留神经、术中及术后镇痛细节等术中详细信息。使用SPSS 21版本进行数据分析。
半骨盆切除术后神经性疼痛并不常见。轻度至中度躯体疼痛的患病率约为30%。根据BPI和MSTS评分评估,功能受限最小。手术切口及其周围区域持续存在较高的麻木发生率(50%)。
这是第一项报告骨盆肿瘤切除术后半骨盆切除术后慢性疼痛发生率的研究。尽管手术切除范围广泛,但该人群中神经性疼痛的患病率较低。然而,持续性躯体疼痛的发生率较高,需要进一步研究以评估其因果关系。