Department of Anesthesiology, Peking University People's Hospital, Beijing, 100044, China.
National Institute of Health Data Science, Peking University, Beijing, 100191, China.
BMC Anesthesiol. 2023 Mar 9;23(1):73. doi: 10.1186/s12871-023-02033-z.
Pain management after pelvic and sacral tumor surgery is challenging and requires a multidisciplinary and multimodal approach. Few data on postoperative pain trajectories have been reported after pelvic and sacral tumor surgery. The aim of this pilot study was to determine pain trajectories within the first 2 weeks after surgery and explore the impact on long-term pain outcomes.
Patients scheduled for pelvic and sacral tumor surgery were prospectively recruited. Worst/average pain scores were evaluated postoperatively using questions adapted from the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) until pain resolution was reached or up to 6 months after surgery. Pain trajectories over the first 2 weeks were compared using the k-means clustering algorithm. Whether pain trajectories were associated with long-term pain resolution and opioid cessation was assessed using Cox regression analysis.
A total of 59 patients were included. Two distinct groups of trajectories for worst and average pain scores over the first 2 weeks were generated. The median pain duration in the high vs low pain group was 120.0 (95% CI [25.0, 215.0]) days vs 60.0 (95% CI [38.6, 81.4]) days (log rank p = 0.037). The median time to opioid cessation in the high vs low pain group was 60.0 (95% CI [30.0, 90.0]) days vs 7.0 (95% CI [4.7, 9.3]) days (log rank p < 0.001). After adjusting for patient and surgical factors, the high pain group was independently associated with prolonged opioid cessation (hazard ratio [HR] 2.423, 95% CI [1.254, 4.681], p = 0.008) but not pain resolution (HR 1.557, 95% CI [0.748, 3.243], p = 0.237).
Postoperative pain is a significant problem among patients undergoing pelvic and sacral tumor surgery. High pain trajectories during the first 2 weeks after surgery were associated with delayed opioid cessation. Research is needed to explore interventions targeting pain trajectories and long-term pain outcomes.
The trial was registered at ClinicalTrials.gov ( NCT03926858 , 25/04/2019).
骨盆和骶骨肿瘤手术后的疼痛管理具有挑战性，需要多学科和多模式的方法。关于骨盆和骶骨肿瘤手术后的术后疼痛轨迹，已有少量数据报道。本初步研究的目的是确定手术后 2 周内的疼痛轨迹，并探讨其对长期疼痛结局的影响。
前瞻性招募计划接受骨盆和骶骨肿瘤手术的患者。使用从修订后的美国疼痛协会患者结局问卷（APS-POQ-R）改编的问题，在术后评估最差/平均疼痛评分，直到疼痛缓解或术后 6 个月。使用 k-均值聚类算法比较前 2 周的疼痛轨迹。使用 Cox 回归分析评估疼痛轨迹是否与长期疼痛缓解和阿片类药物停药相关。
共纳入 59 例患者。在前 2 周内，最差和平均疼痛评分生成了两组不同的轨迹。高疼痛组和低疼痛组的中位疼痛持续时间分别为 120.0（95%CI[25.0，215.0]）天和 60.0（95%CI[38.6，81.4]）天（对数秩检验 p=0.037）。高疼痛组和低疼痛组的中位阿片类药物停药时间分别为 60.0（95%CI[30.0，90.0]）天和 7.0（95%CI[4.7，9.3]）天（对数秩检验 p<0.001）。调整患者和手术因素后，高疼痛组与阿片类药物停药时间延长独立相关（风险比[HR]2.423，95%CI[1.254，4.681]，p=0.008），但与疼痛缓解无关（HR 1.557，95%CI[0.748，3.243]，p=0.237）。
骨盆和骶骨肿瘤手术后患者存在明显的术后疼痛问题。术后前 2 周内的高疼痛轨迹与阿片类药物停药时间延迟有关。需要研究针对疼痛轨迹和长期疼痛结局的干预措施。
该试验在 ClinicalTrials.gov 注册（NCT03926858，2019 年 4 月 25 日）。
