Department of Anaesthesia and Perioperative Medicine, Monash Health, Clayton, Victoria, Australia.
Department of Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, Victoria, Australia.
Paediatr Anaesth. 2024 Aug;34(8):701-719. doi: 10.1111/pan.14918. Epub 2024 May 13.
Two prior reviews highlight the scarcity and conflicting nature of available data on chronic postsurgical pain in children, reporting a wide prevalence range of 3.2% to 64% (at ≥3 months). This updated systematic review aimed to consolidate information on the prevalence of pediatric chronic postsurgical pain. A thorough literature search of full English-text publications from April 2014 to August 2021 was conducted using Ovid MEDLINE, PubMed, and Cochrane Database of Systematic Reviews, with search terms: postoperative pain, child, preschool, pediatrics, adolescent, chronic pain. Seventeen relevant studies were identified. Most assessed chronicity once greater than 3 months duration postoperatively (82%), were predominantly prospective (71%) and conducted in inpatient settings (88%). The surgeries examined included orthopedic (scoliosis and limb), urological, laparotomy, inguinal, and cardiothoracic procedures, involving numbers ranging from 36 to 750, totaling 3137 participants/2792 completers. The studies had wide variations in median age at surgery (6 days to 16 years), the percentage of female participants (unspecified or 12.5% to 90%), and follow-up duration (2.5 months to 9 years). Various pain, functional, psychosocial, and health-related quality of life outcomes were documented. Chronic postsurgical pain prevalence varied widely from 2% to 100%. Despite increased data, challenges persist due to heterogeneity in definitions, patient demographics, mixed versus single surgical populations, diverse perioperative analgesic interventions, follow-up durations and reported outcomes. Interpretation is further complicated by limited information on impact, long-term analgesia and healthcare utilization, and relatively small sample sizes, hindering the assessment of reported associations. In some cases, preoperative pain and deformity may not have been addressed by surgery and persisting pain postoperatively may then be inappropriately termed chronic postsurgical pain. Larger-scale, procedure-specific data to better assess current prevalence, impact, and whether modifiable factors link to negative long-term outcomes, would be more useful and allow targeted perioperative interventions for at-risk pediatric surgical patients.
两篇先前的综述强调了现有儿童慢性术后疼痛数据的稀缺性和矛盾性，报告的患病率范围很广，为 3.2%至 64%（≥3 个月）。本系统综述旨在整合有关儿科慢性术后疼痛患病率的信息。使用 Ovid MEDLINE、PubMed 和 Cochrane 系统评价数据库，对 2014 年 4 月至 2021 年 8 月期间的英文全文出版物进行了全面文献检索，检索词为：术后疼痛、儿童、学龄前儿童、儿科、青少年、慢性疼痛。确定了 17 项相关研究。大多数研究评估了术后超过 3 个月的慢性（82%），主要是前瞻性（71%）和在住院环境中进行（88%）。所检查的手术包括矫形（脊柱侧弯和肢体）、泌尿科、剖腹术、腹股沟和心胸手术，涉及的人数从 36 到 750 不等，总计 3137 名参与者/2792 名完成者。这些研究在手术时的中位年龄（6 天至 16 岁）、女性参与者的百分比（未指定或 12.5%至 90%）和随访时间（2.5 个月至 9 年）方面存在很大差异。记录了各种疼痛、功能、心理社会和健康相关生活质量的结果。慢性术后疼痛的患病率从 2%到 100%不等，差异很大。尽管数据有所增加，但由于定义、患者人口统计学、混合与单一手术人群、不同围手术期镇痛干预、随访时间和报告结果的异质性，仍然存在挑战。由于缺乏关于影响、长期镇痛和医疗保健利用的信息以及相对较小的样本量，报告的关联评估也变得更加复杂。在某些情况下，手术并未解决术前疼痛和畸形，术后持续疼痛可能不恰当地被称为慢性术后疼痛。更大规模、特定于手术的数据将有助于更好地评估当前的患病率、影响以及是否可改变的因素与负面长期结果相关联，这将更加有用，并允许针对高危儿科手术患者进行围手术期干预。
