The Department of Anesthesia and Pain Medicine, The First Affiliated Hospital of Chongqing Medical University, #1 Road Youyi Road, Yuanjiagang Community, Yuzhong District, Chongqing, 400016, China.
The Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children Hospital of Chongqing Medical University, 120# Longshan Road, Yubei District, Chongqing, 401147, China.
J Anesth. 2023 Oct;37(5):775-786. doi: 10.1007/s00540-023-03235-y. Epub 2023 Aug 1.
To optimize the efficacy of analgesia and post-operative recovery for patients undergoing laparoscopic colorectal surgery by integrating a composite psycho-somatic analgesia algorithm involving peri-operative rehabilitation exercise and pain neuroscience education into multi-modal analgesia.
A prospective randomized controlled trial was conducted to compare conventional peri-operative analgesia (group CA) and the addition of rehabilitation exercise and pain neuroscience education into it (group REPNE) for patients undergoing laparoscopic colorectal surgery. Acute and chronic post-operative pain, characteristics of pain (pain catastrophizing, sensitization, and trends of neuropathic transformation), and quality of post-operative recovery calibrated with EuroQol Five Dimensions Questionnaire (EQ-5D-5L) were investigated and compared between two groups.
A total of 175 patients consented to participate in this study. Compared with those receiving conventional analgesia (group CA, N = 89), patients in group REPNE (N = 86) reported reduced intensity of pain 24 h after surgery, less risk of pain catastrophizing and sensitization, and better quality of life during hospitalization recovery till 1 month after surgery (p < 0.05). No statistical difference was found for neuropathic transformation of post-operative pain or for the incidence of chronic post-operative pain (p > 0.05).
The addition of peri-operative rehabilitation exercise and pain neuroscience education into multi-modal analgesia provided better analgesic effect compared with routine practice for patients receiving laparoscopic colorectal surgery and also facilitated better post-operative recovery. This composite psycho-somatic algorithm for peri-operative analgesia merits further application in clinical practice.
通过将围手术期康复锻炼和疼痛神经科学教育纳入多模式镇痛，优化接受腹腔镜结直肠手术患者的镇痛效果和术后恢复。
进行了一项前瞻性随机对照试验，比较了常规围手术期镇痛（CA 组）和在此基础上增加康复锻炼和疼痛神经科学教育（REPNE 组）对接受腹腔镜结直肠手术患者的效果。比较两组患者术后急性和慢性疼痛、疼痛特征（疼痛灾难化、敏化和神经病理性转化趋势）以及术后恢复质量（采用 EuroQol Five Dimensions Questionnaire 5L 量表进行评估）。
共有 175 例患者同意参加本研究。与接受常规镇痛的患者（CA 组，N=89）相比，接受 REPNE 组（N=86）的患者术后 24 小时疼痛强度降低，疼痛灾难化和敏化风险降低，术后住院恢复期间生活质量更好，直至术后 1 个月（p<0.05）。两组患者术后疼痛的神经病理性转化或慢性术后疼痛的发生率无统计学差异（p>0.05）。
与常规治疗相比，围手术期康复锻炼和疼痛神经科学教育的加入可提高接受腹腔镜结直肠手术患者的镇痛效果，促进术后恢复。这种围手术期心理-躯体复合镇痛算法值得在临床实践中进一步应用。
