Michel-Cherqui Mireille, Fessler Julien, Dorges Pascaline, Szekély Barbara, Sage Edouard, Glorion Matthieu, Fischler Marc, Martinez Valéria, Labro Mathilde, Vallée Alexandre, Le Guen Morgan
Department of Anesthesiology and Pain Management, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France.
Université Versailles-Saint-Quentin-en-Yvelines, 78000, Versailles, France.
J Anesth. 2023 Oct;37(5):687-702. doi: 10.1007/s00540-023-03221-4. Epub 2023 Aug 13.
Post-thoracotomy pain syndrome (PTPS) and chronic postsurgical neuropathic pain (CPNP) were evaluated 4 months after thoracic surgery whether the approach was a posterolateral (PL) incision or the less invasive axillary (AX) one.
Patients, 79 in each group, undergoing a thoracotomy between July 2014 and November 2015 were analyzed 4 months after surgery in this prospective monocentric cohort study.
More PL patients suffered PTPS (60.8% vs. 40.5%; p = 0.017) but CPNP was equally present (45.8% and 46.9% in the PL and AX groups). Patients with PTPS have more limited daily activities (p < 0.001) but a similar psychological disability (i.e., catastrophism). Patients with CPNP have an even greater limitation of daily activities (p = 0.007) and more catastrophism (p = 0.0002). Intensity of pain during mobilization of the homolateral shoulder at postoperative day 6 (OR = 1.40, CI 95% [1.13-1.75], p = 0.002); age (OR = 0.97 [0.94-1.00], p = 0.022), and presence of pain before surgery (OR = 2.22 [1.00-4.92], p = 0.049) are related to the occurrence of PTPS; while, height of hypoesthesia area on the breast line measured 6 days after surgery is the only factor related to that of CPNP (OR = 1.14 [1.01-1.30], p = 0.036).
Minimally invasive surgery was associated with less frequent PTPS, but with equal risk of CPNP. Pain before surgery and its postoperative intensity are associated with PTPS. This must lead to a more aggressive care of pain patients before surgery and of a better management of postoperative pain. CPNP can be forecasted according to the early postoperative height of hypoesthesia area on the breast line.
在胸外科手术后4个月，评估开胸术后疼痛综合征（PTPS）和慢性术后神经性疼痛（CPNP）情况，手术方式为后外侧（PL）切口或创伤较小的腋下（AX）切口。
在这项前瞻性单中心队列研究中，分析了2014年7月至2015年11月期间接受开胸手术的患者，每组79例，术后4个月进行评估。
更多接受PL手术的患者患有PTPS（60.8%对40.5%；p = 0.017），但CPNP的发生率相当（PL组和AX组分别为45.8%和46.9%）。患有PTPS的患者日常活动受限更明显（p < 0.001），但心理残疾程度相似（即灾难化思维）。患有CPNP的患者日常活动受限更严重（p = 0.007），且灾难化思维更严重（p = 0.0002）。术后第6天患侧肩部活动时的疼痛强度（OR = 1.40，95%CI[1.13 - 1.75]，p = 0.002）、年龄（OR = 0.97[0.94 - 1.00]，p = 0.022）以及术前存在疼痛（OR = 2.22[1.00 - 4.92]，p = 0.049）与PTPS的发生有关；而术后6天测量的胸骨旁感觉减退区域的高度是与CPNP发生相关的唯一因素（OR = 1.14[1.01 - 1.30]，p = 0.036）。
微创手术与PTPS发生率较低相关，但CPNP风险相同。术前疼痛及其术后强度与PTPS相关。这必然导致在术前对疼痛患者进行更积极的护理，并更好地管理术后疼痛。CPNP可根据术后早期胸骨旁感觉减退区域的高度进行预测。
