Li Yi-Shiuan, Chang Kuang-Yi, Lin Shih-Pin, Chang Ming-Chau, Chang Wen-Kuei
Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Front Med (Lausanne). 2022 Aug 22;9:907126. doi: 10.3389/fmed.2022.907126. eCollection 2022.
This retrospective study was designed to explore the types of postoperative pain trajectories and their associated factors after spine surgery.
This study was conducted in a single medical center, and patients undergoing spine surgery with intravenous patient-controlled analgesia (IVPCA) for postoperative pain control between 2016 and 2018 were included in the analysis. Maximal pain scores were recorded daily in the first postoperative week, and group-based trajectory analysis was used to classify the variations in pain intensity over time and investigate predictors of rebound pain after the end of IVPCA. The relationships between the postoperative pain trajectories and the amount of morphine consumption or length of hospital stay (LOS) after surgery were also evaluated.
A total of 3761 pain scores among 547 patients were included in the analyses and two major patterns of postoperative pain trajectories were identified: Group 1 with mild pain trajectory (87.39%) and Group 2 with rebound pain trajectory (12.61%). The identified risk factors of the rebound pain trajectory were age less than 65 years (odds ratio [OR]: 1.89; 95% : 1.12-3.20), female sex (: 2.28; 95% : 1.24-4.19), and moderate to severe pain noted immediately after surgery (: 3.44; 95% : 1.65-7.15). Group 2 also tended to have more morphine consumption ( < 0.001) and a longer length of hospital stay ( < 0.001) than Group 1.
The group-based trajectory analysis of postoperative pain provides insight into the patterns of pain resolution and helps to identify unusual courses. More aggressive pain management should be considered in patients with a higher risk for rebound pain after the end of IVPCA for spine surgery.
本回顾性研究旨在探讨脊柱手术后术后疼痛轨迹的类型及其相关因素。
本研究在单一医疗中心进行，纳入2016年至2018年间接受脊柱手术并采用静脉自控镇痛（IVPCA）进行术后疼痛控制的患者进行分析。术后第一周每天记录最大疼痛评分，并采用基于组的轨迹分析来分类疼痛强度随时间的变化，并调查IVPCA结束后反弹痛的预测因素。还评估了术后疼痛轨迹与术后吗啡消耗量或住院时间（LOS）之间的关系。
共纳入547例患者的3761个疼痛评分进行分析，确定了两种主要的术后疼痛轨迹模式：第1组为轻度疼痛轨迹（87.39%），第2组为反弹痛轨迹（12.61%）。确定的反弹痛轨迹的危险因素为年龄小于65岁（比值比[OR]：1.89；95%：1.12 - 3.20）、女性（OR：2.28；95%：1.24 - 4.19）以及术后立即出现中度至重度疼痛（OR：3.44；95%：1.65 - 7.15）。第2组的吗啡消耗量也往往比第1组更多（P < 0.001），住院时间更长（P < 0.001）。
基于组的术后疼痛轨迹分析有助于深入了解疼痛缓解模式，并有助于识别异常病程。对于脊柱手术IVPCA结束后反弹痛风险较高的患者，应考虑更积极的疼痛管理。
