Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Penn State College of Medicine, Hershey, PA, USA.
Hand (N Y). 2024 Sep;19(6):1012-1018. doi: 10.1177/15589447231160207. Epub 2023 Mar 23.
Carpal tunnel release (CTR) is one of the most common hand surgeries. Studies have highlighted a mental-physical connection to hand pathologies and psychological connections to postoperative pain burden. Post-traumatic stress disorder (PTSD) has been identified as a medical-psychological comorbidity like other mental health disorders such as generalized anxiety disorder (GAD). There remains a gap in the literature regarding PTSD as a comorbidity for hand surgeries, where there is this mental-physical connection. We hypothesize PTSD will be associated with increased risk of postoperative pain, evidenced by greater prevalence of opioid usage.
The authors performed a retrospective analysis using the TriNetX Research Database. Patients who underwent elective CTR were identified within the database. Two groups were created and compared against individual controls: the first was identified based on the diagnosis of PTSD, and the second was identified based on the diagnosis of GAD. Cohorts were matched and opioid usage was compared postoperatively.
Patients with PTSD who underwent CTR were found to be at significantly increased risk of postoperative opioid use ( = .033) and more likely to present to the emergency department (ED) ( = .001). Patients with GAD were found to be significantly less likely to require postoperative opioids ( = .040).
We found patients with PTSD to be at increased risk of opioid use and more likely to present to ED following CTR. Patients with GAD were found to be at decreased risk of opioid use after CTR. Owing to the independent significant risks not found in GAD, further research of postoperative pain in patients with PTSD is needed.
腕管松解术（CTR）是最常见的手部手术之一。研究强调了手部病理与心理-生理之间的联系，以及与术后疼痛负担之间的心理联系。创伤后应激障碍（PTSD）已被确定为一种医学-心理共病，与其他精神健康障碍（如广泛性焦虑障碍）一样。在手外科手术中，PTSD 作为一种合并症，存在这种心理-生理联系，但文献中仍存在空白。我们假设 PTSD 与术后疼痛风险增加有关，表现为阿片类药物使用的患病率更高。
作者使用 TriNetX 研究数据库进行了回顾性分析。在数据库中确定了接受选择性 CTR 的患者。创建了两组并与个体对照组进行比较：第一组基于 PTSD 的诊断确定，第二组基于 GAD 的诊断确定。对队列进行匹配，并比较术后阿片类药物的使用情况。
发现接受 CTR 的 PTSD 患者术后使用阿片类药物的风险显著增加（ =.033），更有可能到急诊就诊（ =.001）。GAD 患者术后使用阿片类药物的可能性显著降低（ =.040）。
我们发现 PTSD 患者使用阿片类药物的风险增加，并且在接受 CTR 后更有可能到急诊就诊。GAD 患者在接受 CTR 后使用阿片类药物的风险降低。由于 GAD 中未发现独立的显著风险，因此需要对 PTSD 患者的术后疼痛进行进一步研究。
