Ali Fathalla, Wallin Göran, Wahlin Rebecka Rubenson, Montgomery Agneta, Rogmark Peder, Sandblom Gabriel
Faculty of Medicine and Health, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Division of Anesthesiology and Intensive Care, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Huddinge, Sweden.
Hernia. 2025 Jan 15;29(1):68. doi: 10.1007/s10029-025-03256-4.
The aim of this study was to evaluate risk factors for postoperative pain and nausea after open repair for primary ventral hernias.
A population-based registry study was conducted based on data assembled from the Swedish national ventral hernia repair register between January 2016 and December 2021and cross-matched with the Swedish perioperative register.
Altogether 2064 open ventral hernia repairs were registered, including 816 (39.5%) performed on women. Of these, 91 (4.4%) were registered to suffer postoperative nausea or vomiting (PONV) and 403 (19.5%) postoperative pain (PP). In both univariable and multivariable logistic regression analyses, significant predictors of postoperative nausea and pain included male gender, which was associated with lower odds of both postoperative nausea (multivariable OR: 0.30, 95% CI: 0.18-0.49, P < 0.001) and postoperative pain (multivariable OR: 0.60, 95% CI: 0.44-0.83, P = 0.002). Additional predictors of postoperative nausea included emergency surgery (multivariable OR: 4.08, 95% CI: 1.10-15.08, P = 0.035), operative time > 40 min (multivariable OR: 4.15, 95% CI: 2.24-7.69, P < 0.001). Conversely total intravenous anesthesia was associated with lower incidence of PONV (multivariable OR: 0.40, 95% CI: 0.22-0.74, P = 0.003). Other factors, such as age, BMI, smoking status, ASA classification, hernia size, surgery type, operative time, and anesthesia type, were not significantly associated with postoperative pain after adjusting for other variables.
Postoperative nausea and vomiting (PONV) are significantly reduced with total intravenous anesthesia (TIVA) compared to inhalation anesthesia, with no notable difference in postoperative pain between the two methods.
本研究旨在评估原发性腹疝开放修补术后疼痛和恶心的危险因素。
基于2016年1月至2021年12月期间从瑞典国家腹疝修补登记处收集的数据，并与瑞典围手术期登记处进行交叉匹配，开展了一项基于人群的登记研究。
共登记了2064例开放性腹疝修补术，其中816例（39.5%）为女性患者。其中，91例（4.4%）登记有术后恶心或呕吐（PONV），403例（19.5%）有术后疼痛（PP）。在单变量和多变量逻辑回归分析中，术后恶心和疼痛的显著预测因素包括男性性别，这与术后恶心（多变量OR：0.30，95%CI：0.18 - 0.49，P < 0.001）和术后疼痛（多变量OR：0.60，95%CI：0.44 - 0.83，P = 0.002）的较低几率相关。术后恶心的其他预测因素包括急诊手术（多变量OR：4.08，95%CI：1.10 - 15.08，P = 0.035）、手术时间>40分钟（多变量OR：4.15，95%CI：2.24 - 7.69，P < 0.001）。相反，全静脉麻醉与较低的PONV发生率相关（多变量OR：0.40，95%CI：0.22 - 0.74，P = 0.003）。在调整其他变量后，年龄、BMI、吸烟状况、ASA分级、疝大小、手术类型、手术时间和麻醉类型等其他因素与术后疼痛无显著关联。
与吸入麻醉相比，全静脉麻醉（TIVA）可显著降低术后恶心和呕吐（PONV），两种方法术后疼痛无显著差异。
