Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, People's Republic of China.
Int J Surg. 2023 Dec 1;109(12):3872-3882. doi: 10.1097/JS9.0000000000000672.
Most patients are in a noisy environment during abdominal surgery under general anesthesia. This study included patients who underwent abdominal surgery under general anesthesia and established an animal model to determine whether intraoperative noise affects postoperative pain.
This prospective study included 200 patients who underwent abdominal surgery under general anesthesia. Intraoperative noise and electroencephalograms were continuously recorded, and the mean level and time proportion of noise intensity of greater than 70 dB were calculated. Maximum postoperative pain was assessed using a numerical rating scale at 0-12 h and 12-24 h after surgery, and postoperative analgesia consumption in patients receiving patient-controlled intravenous analgesia was recorded. Postoperative pain intensity and electroencephalogram amplitude were compared between patients with high-noise exposure (time proportion of noise intensity greater than 70 dB ≥40%) and low-noise exposure (<40%). Mechanical pain sensitivity was tested in two groups of mice with plantar incisions exposed to 40 dB or 70-100 dB.
The time proportion of noise intensity greater than 70 dB was identified as an independent risk factor for postoperative pain intensity ( P <0.001). P ain numerical rating scale 0-12 h (4.5±1.5 vs. 3.7±1.3, P =0.001) and 12-24 h (3.9±1.5 vs. 3.2±1.1, P =0.004) after surgery in patients with high-noise exposure was significantly higher than in patients with low-noise exposure. The electroencephalogram amplitude of patients with high-noise exposure was significantly lower than that of patients with low-noise exposure ( P <0.05). In the mouse model, mechanical hyperalgesia in the 70-100 dB group was significantly greater than that in the 40 dB group ( P <0.001).
High-level intraoperative noise exposure aggravates the degree of postoperative pain and analgesic needs of patients undergoing abdominal surgery, which may be related to the impact of noise on the neurophysiological activity of the brain and postoperative hyperalgesia.
大多数患者在全身麻醉下进行腹部手术时处于嘈杂的环境中。本研究纳入了全身麻醉下接受腹部手术的患者，并建立了动物模型，以确定术中噪声是否会影响术后疼痛。
这是一项前瞻性研究，共纳入 200 例全身麻醉下接受腹部手术的患者。连续记录术中噪声和脑电图，计算噪声强度大于 70dB 的平均水平和时间比例。术后 0-12h 和 12-24h 采用数字评分量表评估最大术后疼痛，记录接受患者自控静脉镇痛的患者术后镇痛药物的消耗。比较高噪声暴露（噪声强度大于 70dB 的时间比例≥40%）和低噪声暴露（<40%）患者的术后疼痛强度和脑电图振幅。对两组接受足底切口的小鼠进行机械性疼痛敏感性测试，分别暴露于 40dB 或 70-100dB。
噪声强度大于 70dB 的时间比例被确定为术后疼痛强度的独立危险因素（P<0.001）。高噪声暴露组患者术后 0-12h（4.5±1.5 vs. 3.7±1.3，P=0.001）和 12-24h（3.9±1.5 vs. 3.2±1.1，P=0.004）的疼痛数字评分量表显著高于低噪声暴露组。高噪声暴露组患者的脑电图振幅明显低于低噪声暴露组（P<0.05）。在小鼠模型中，70-100dB 组的机械性痛觉过敏明显大于 40dB 组（P<0.001）。
术中高强度噪声暴露加重了腹部手术患者的术后疼痛程度和镇痛需求，这可能与噪声对大脑神经生理活动和术后痛觉过敏的影响有关。
