Thomas T, Robinson C, Champion D, McKell M, Pell M
St Vincent's Private Hospital, Darlinghurst, NSW, Australia.
Pain. 1998 Apr;75(2-3):177-85. doi: 10.1016/s0304-3959(97)00218-2.
A prospective observational study of cohorts of patients undergoing hip replacement (30), knee replacement (31), and spinal nerve root decompressive surgery (30) were interviewed pre-operatively to identify factors which might correlate with and potentially predict severe post-operative pain and dissatisfaction with analgesic management. The hip patients comprised 33% females and averaged 64 years, while the knee patients were 45% female and older (mean 71 years) and the spinal patients were 43% female and averaged 50 years. The three groups were similar with respect to all other pre-operative variables. Pain intensity was assessed mainly by self-report using the Present Pain Intensity (PPI) and Visual Analogue Scales (VAS) of the McGill Pain Questionnaire. The PPI was preferred by patients and nurses and, as there were no analytical advantages for the VAS, the PPI data are presented. The average post-operative pain during routine management mainly with patient controlled intravenous opiate, was mild to moderate and declined over days 1-5, declined further at discharge but rose slightly 1 month after discharge. The hip replacement patients experienced significantly (P < 0.01) less pain overall than the patients in the other two groups. Nurses' assessments of pain severity from observed behaviour were low and agreed poorly with the patients' self reports. Assessed on Likert Scales (0-6), the patients generally indicated good or excellent pain control, better than expected pain experience, and high levels of satisfaction with analgesic management. Significant (P < or = 0.01) multivariate correlates of severe post-operative pain assessed by logistic regression analysis of 11 variables were female gender, high pre-operative pain severity, and younger age. Significant (P < or = 0.01) multivariate correlates of both worse than expected pain experience and low satisfaction were female gender, high pre-operative pain severity, high anxiety about risks and problems, low expected pain severity, age (younger) and high willingness to report pain. These variables may reasonably be tested in further studies as potential predictors of adverse post-operative pain experience.
一项前瞻性观察性研究对接受髋关节置换术（30例）、膝关节置换术（31例）和脊神经根减压手术（30例）的患者队列进行了术前访谈，以确定可能与严重术后疼痛相关并潜在预测术后疼痛以及对镇痛管理不满的因素。髋关节置换患者中女性占33%，平均年龄64岁，膝关节置换患者中女性占45%，年龄更大（平均71岁），脊柱手术患者中女性占43%，平均年龄50岁。三组在所有其他术前变量方面相似。疼痛强度主要通过使用麦吉尔疼痛问卷的当前疼痛强度（PPI）和视觉模拟量表（VAS）进行自我报告来评估。患者和护士更倾向于使用PPI，并且由于VAS没有分析优势，因此呈现的是PPI数据。在主要采用患者自控静脉注射阿片类药物的常规管理期间，术后平均疼痛为轻度至中度，并在第1 - 5天有所减轻，出院时进一步减轻，但出院后1个月略有上升。髋关节置换患者总体疼痛明显（P < 0.01）少于其他两组患者。护士根据观察到的行为对疼痛严重程度的评估较低，且与患者的自我报告一致性较差。根据李克特量表（0 - 6）评估，患者总体表示疼痛控制良好或优秀，疼痛体验优于预期，并且对镇痛管理满意度较高。通过对11个变量进行逻辑回归分析评估，严重术后疼痛的显著（P ≤ 0.01）多变量相关因素为女性性别、术前疼痛严重程度高和年龄较小。比预期疼痛体验更差和满意度低的显著（P ≤ 0.01）多变量相关因素为女性性别、术前疼痛严重程度高、对风险和问题的高焦虑、预期疼痛严重程度低、年龄（较小）以及报告疼痛的高意愿。这些变量可在进一步研究中作为术后不良疼痛体验的潜在预测因素进行合理测试。
