Chang Brian L, Mondshine Josh, Hill Alison, Fleury Christopher M, Kleiber Grant M
Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, D.C.
Plast Reconstr Surg Glob Open. 2022 Jul 15;10(7):e4434. doi: 10.1097/GOX.0000000000004434. eCollection 2022 Jul.
In peripheral nerve surgery, the presence of psychiatric diagnoses and medications may affect outcomes and perioperative neuropathic pain management. The purpose of this study was to determine the prevalence of psychiatric diagnoses and chronic pain in patients referred to a peripheral nerve surgery clinic.
This is a retrospective review of patients seen at a peripheral nerve clinic from July 1, 2017 to June 30, 2021. Medical records were reviewed for demographics; peripheral nerve diagnosis; psychiatric diagnoses; psychotropic prescriptions; use of nonneuroleptic/nonnarcotic, neuroleptic, and narcotic medications; and peripheral nerve surgical candidacy and outcome.
Six hundred twenty-two patients were included in this study. The most common reasons for referral were 24.8% lower extremity neuroma, 23.2% lower extremity compressive neuropathy, and 14.0% upper extremity compressive neuropathy. Of the included patients' 37.1% had a psychiatric diagnosis, and 36.3% were taking a psychotropic medication. The percentage of patients taking chronic nonneuroleptic/nonnarcotic pain medications was 34.3%' with 42.8% taking neuroleptic, and 24.9% narcotic medications. Patients with a psychiatric diagnosis were more likely to be taking neuroleptic (48.9% versus 38.9%, < 0.001) and narcotic pain medications (27.3% versus 17.4%, = 0.004) and less likely to have a positive surgical outcome (65.7% versus 83.0%, = 0.001).
Patients referred to a peripheral nerve surgery clinic frequently have psychiatric diagnoses and take chronic psychotropic and chronic pain medications. Knowledge of this will best help the peripheral nerve surgeon evaluate a patient for surgery, optimize perioperative care, and safely and effectively manage expectations.
在周围神经外科手术中，精神疾病诊断和药物治疗的存在可能会影响手术结果和围手术期神经性疼痛的管理。本研究的目的是确定转诊至周围神经外科诊所的患者中精神疾病诊断和慢性疼痛的患病率。
这是一项对2017年7月1日至2021年6月30日在周围神经诊所就诊患者的回顾性研究。对病历进行了人口统计学、周围神经诊断、精神疾病诊断、精神药物处方、非抗精神病药/非麻醉药、抗精神病药和麻醉药的使用以及周围神经手术候选资格和结果的审查。
本研究纳入了622例患者。最常见的转诊原因是下肢神经瘤占24.8%，下肢压迫性神经病变占23.2%，上肢压迫性神经病变占14.0%。在所纳入的患者中，37.1%有精神疾病诊断，36.3%正在服用精神药物。服用慢性非抗精神病药/非麻醉性止痛药的患者比例为34.3%，服用抗精神病药的为42.8%，服用麻醉药的为24.9%。有精神疾病诊断的患者更有可能服用抗精神病药（48.9%对38.9%，<0.001）和麻醉性止痛药（27.3%对17.4%，=0.004），而手术结果为阳性的可能性较小（65.7%对83.0%，=0.001）。
转诊至周围神经外科诊所的患者经常有精神疾病诊断，并服用慢性精神药物和慢性疼痛药物。了解这一点将最有助于周围神经外科医生评估患者是否适合手术，优化围手术期护理，并安全有效地管理患者的期望。
