Spaans Louisa N, Vriens Lois, Roumen Rudi M H, Dijkgraaf Marcel G W, Verhagen Ad F T M, Bouwman R Arthur, van den Broek Frank J C
Department of Surgery, Maxima Medical Center, Eindhoven, The Netherlands.
Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
J Thorac Dis. 2024 Oct 31;16(10):6553-6564. doi: 10.21037/jtd-24-802. Epub 2024 Oct 29.
Despite the benefits of video-assisted thoracoscopic surgery (VATS), postoperative acute pain and nerve injury are still present and contribute to early persistent and chronic pain. The purpose of this study is to describe the incidence of early persistent pain (EPP) after VATS, which remains unexplored, to enhance patient care and promote awareness among clinicians regarding this clinical condition.
A single-center prospective cohort study that included consecutive patients undergoing VATS between January 2021 and March 2023. The primary outcome was the incidence of EPP, defined as pain experienced at 3 to 4 weeks follow-up. Secondary outcomes were risk factors associated with EPP, characteristics during physical examination, acute postoperative pain scores, the use of additional analgesia and complications between patients with and without EPP.
Of 117 patients, 16.2% [95% confidence interval (CI): 9-23%] developed EPP. The presence of acute postoperative pain was the only risk factor for EPP. The pain was mostly localized at the utility and ventral incision. Hyperesthesia, hypoesthesia and a positive pinch test were the most common sensory disturbances. Patients with EPP showed significantly higher acute pain scores until postoperative day (POD) 4, more frequently used additional opioids until POD 2, and had comparable complications.
Early persistent postoperative pain is present in 16.2% of patients after VATS. Acute postoperative pain is the strongest risk factor for developing such persistent pain. This underlines that awareness of clinicians for strategies that optimize postoperative pain management is of utmost importance.
尽管电视辅助胸腔镜手术（VATS）有诸多益处，但术后急性疼痛和神经损伤仍然存在，并导致早期持续性疼痛和慢性疼痛。本研究的目的是描述VATS后早期持续性疼痛（EPP）的发生率，这一发生率尚未得到研究，旨在改善患者护理，并提高临床医生对这种临床情况的认识。
一项单中心前瞻性队列研究，纳入了2021年1月至2023年3月期间连续接受VATS的患者。主要结局是EPP的发生率，定义为在随访3至4周时经历的疼痛。次要结局是与EPP相关的危险因素、体格检查特征、术后急性疼痛评分、额外镇痛药物的使用以及有和没有EPP的患者之间的并发症。
117例患者中，16.2%[95%置信区间（CI）：9 - 23%]发生了EPP。术后急性疼痛的存在是EPP的唯一危险因素。疼痛大多局限于实用切口和腹侧切口。感觉过敏、感觉减退和捏压试验阳性是最常见的感觉障碍。有EPP的患者在术后第4天之前急性疼痛评分显著更高，在术后第2天之前更频繁地使用额外的阿片类药物，且并发症相当。
VATS术后16.2%的患者存在早期持续性术后疼痛。术后急性疼痛是发生这种持续性疼痛的最强危险因素。这强调了临床医生对优化术后疼痛管理策略的认识至关重要。
