Lynch E P, Lazor M A, Gellis J E, Orav J, Goldman L, Marcantonio E R
Department of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA.
Anesth Analg. 1997 Jul;85(1):117-23. doi: 10.1097/00000539-199707000-00021.
The purpose of this study was to examine the extent and evolution of pain after common major surgical procedures and to establish correlates of three types of pain: pain at rest, pain with movement, and maximum pain over the previous 24 h. Patients completed a preoperative questionnaire to obtain data on age, gender, narcotic use, baseline level of pain, chronicity of pain, and level of anxiety. Patients were then interviewed on Postoperative Days 1, 2, and 3 to assess their pain on a scale of 0 (none) to 10 (worst imaginable). The mean pain score at rest was 2.6 on Postoperative Day 1 and decreased to 2.3 on Postoperative Day 3 (P = 0.06). The mean pain score with movement was 4.5 on Postoperative Day 1, which decreased to 4.2 on Postoperative Day 3 (P = 0.03). The mean maximum pain score over the previous 24 h was 6.3, which decreased to 5.6 (P = 0.0001). Preoperative narcotic use and high baseline preoperative pain, defined as a score > or = 4, were significantly (P < 0.05) associated with increased pain at rest, pain with movement, and maximum pain. Epidural analgesia was the only mode of analgesia significantly associated with both decreased postoperative pain at rest and decreased pain with movement (P < 0.05). These relatively high pain scores and minimum decreases in pain from Postoperative Days 1 to 3 emphasizes the need for more effective pain management continuing into the postoperative period to facilitate mobilization and recovery.
本研究的目的是检查常见大手术后疼痛的程度和演变情况，并确定三种疼痛类型的相关因素：静息痛、运动痛以及过去24小时内的最大疼痛。患者完成一份术前问卷，以获取有关年龄、性别、麻醉药物使用情况、疼痛基线水平、疼痛慢性程度和焦虑水平的数据。然后在术后第1天、第2天和第3天对患者进行访谈，以0（无）至10（难以想象的剧痛）的量表评估他们的疼痛程度。术后第1天静息痛的平均疼痛评分为2.6，术后第3天降至2.3（P = 0.06）。术后第1天运动痛的平均疼痛评分为4.5，术后第3天降至4.2（P = 0.03）。过去24小时内的平均最大疼痛评分为6.3，降至5.6（P = 0.0001）。术前使用麻醉药物以及术前疼痛基线水平较高（定义为评分≥4）与静息痛、运动痛和最大疼痛增加显著相关（P < 0.05）。硬膜外镇痛是唯一与术后静息痛减轻和运动痛减轻均显著相关的镇痛方式（P < 0.05）。这些相对较高的疼痛评分以及术后第1天至第3天疼痛的最小程度减轻强调了在术后持续进行更有效疼痛管理以促进活动和恢复的必要性。
