Department of Anesthesia, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada.
Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
Curr Med Res Opin. 2024 Jul;40(7):1187-1193. doi: 10.1080/03007995.2024.2360128. Epub 2024 Jun 7.
The incidence and factors associated with chronic postsurgical pain (CPSP) after ambulatory surgeries have not been well studied. Our primary objective was to determine the incidence of CPSP and secondary objectives included assessment of intensity of CPSP, incidence of moderate-to-severe CPSP, and exploration of factors associated with CPSP.
This is a prospective cohort study of ambulatory surgery patients having procedures with a potential to cause moderate-to-severe postoperative pain. All patients had participated in a randomized controlled trial (RCT) showing no difference in achieving satisfactory analgesia in a recovery unit with either morphine or hydromorphone. CPSP was defined as chronic pain that developed or increased in intensity after the surgical procedure and is localized to the surgical field or within the innervation territory of a nerve in the surgical field, and has persisted for 3 months post-surgery, with the exclusion of other causes of pain. Incidences of CPSP were reported as rate (%) with 95% CI, and intensity using a 0-10 numerical rating scale (95% CI). We used logistic regression to explore factors associated with CPSP adjusting for baseline catastrophizing and depression.
Among 402 RCT patients, 208 provided data for the 3-month outcome. Incidence of CPSP was 18.8% (39/208), 95% CI = 13.7%-24.7% and 78% (28/39) of them had moderate-to-severe CPSP. Average CPSP intensity was 5.5, 95% CI = 4.7-6.4. Every unit increase in pain over the first 24 h was significantly associated with increased odds of moderate-to-severe CPSP at 3 months; odds ratio = 1.28, 95% CI = 1.04-1.58.
Nearly one in five patients develop CPSP after ambulatory surgeries with the majority of them having moderate-to-severe pain. Considering that acute pain after discharge is associated with CPSP and that there are no formal care pathways to address this need, studies need to focus on evaluating feasible strategies to provide continuing care.
门诊手术后慢性术后疼痛（CPSP）的发生率和相关因素尚未得到很好的研究。我们的主要目的是确定 CPSP 的发生率，次要目标包括评估 CPSP 的强度、中重度 CPSP 的发生率，并探讨与 CPSP 相关的因素。
这是一项对接受有潜在引起中重度术后疼痛手术的门诊手术患者的前瞻性队列研究。所有患者均参加了一项随机对照试验（RCT），该试验表明，在恢复室中使用吗啡或氢吗啡酮镇痛，在达到令人满意的镇痛效果方面没有差异。CPSP 被定义为手术后出现或加重的慢性疼痛，且局限于手术部位或手术部位神经支配区域内，并持续 3 个月以上，排除其他疼痛原因。CPSP 的发生率以发生率（%）和 95%置信区间（CI）报告，并使用 0-10 数字评分量表（95%CI）报告强度。我们使用逻辑回归模型来探讨与 CPSP 相关的因素，调整基线灾难化和抑郁。
在 402 名 RCT 患者中，有 208 名患者提供了 3 个月的结果数据。CPSP 的发生率为 18.8%（39/208），95%CI=13.7%-24.7%，其中 78%（28/39）为中重度 CPSP。CPSP 的平均强度为 5.5，95%CI=4.7-6.4。前 24 小时疼痛每增加 1 个单位，与 3 个月时发生中重度 CPSP 的几率增加显著相关；优势比=1.28，95%CI=1.04-1.58。
近五分之一的门诊手术患者会发生 CPSP，其中大多数患者有中重度疼痛。考虑到出院后急性疼痛与 CPSP 相关，而且没有正式的护理途径来满足这一需求，因此需要研究关注评估可行的策略来提供持续护理。
