【罂粟摘要】肛门直肠手术术前压力痛阈与术后疼痛的相关性：一项前瞻性观察研究
肛门直肠手术术前压力痛阈与术后疼痛的相关性：一项前瞻性观察研究
贵州医科大学 高鸿教授课题组
翻译：任文鑫 编辑：佟睿 审校：曹莹
术后疼痛管理是患者满意度的关键。压力痛阈（PPT）已在一些外科队列中进行了研究，但尚未研究其与接受肛肠手术的短期住院患者术后急性疼痛的关系。我们假设，术前PPT测量可以识别出术后疼痛程度较高的患者。为了解PPT与术后主观疼痛感觉的关系，我们对短期住院的肛门直肠手术患者术前PPT与术后视觉模拟评分(VAS)评分及术后镇痛剂用量相关的假设进行了检验。
我们前瞻性地评估了一组接受肛门直肠手术的患者的术前PPT，该手术被称为中度至重度疼痛的手术。采用线性混合效应模型评价术后第1、3天及术后4周VAS评分与疼痛评分的关系。采用Logistic回归分析术后额外镇痛药用量的关系。
我们研究了128名患者，发现术前PPT与术后疼痛显著相关(交互作用的P值=0.025)。Logistic回归模型还揭示了术前PPT与术后需要额外止痛药之间的关系，PPT每增加1个点，需要额外止痛药的几率降低约10%。(优势比[OR]=0.90；95%置信区间[CI]，00.81-0.98；P=0. 012)。
术前PPT与术后疼痛有关，可能有助于确定哪些患者有可能在肛门直肠手术后出现更严重的疼痛。特别是在门诊和短期住院环境中，这种方法可以帮助患者解决疼痛敏感度的高度变异性，以促进适当的术后镇痛，及时出院，并防止再次入院。
原始文献来源：
Markus M. Luedi, Patrick Schober,MMedStat, Bassam Hammoud, Preoperative Pressure Pain Threshold Is Associated With Postoperative Pain in Short-Stay Anorectal Surgery: A Prospective Observational Study.Anesth Analg 2021;132:656–62.
Preoperative Pressure Pain Threshold Is Associated With Postoperative Pain in Short-Stay Anorectal Surgery: A Prospective Observational Study
Background: Postoperative pain management is key for patient satisfaction. Pressure pain threshold (PPT) has been studied in some surgical cohorts but has not been studied in relationship to acute postoperative pain in short-stay patients undergoing anorectal surgery. We hypothesized that preoperative finger PPT measurements can identify respective patients with higher postoperative pain. Aiming to understand the relationship with subjective postoperative pain perception, we tested the hypotheses that preoperative PPT is associated with postoperative Visual Analog Scale (VAS) pain scores and correlates with postoperative analgesic consumption in short-stay patients undergoing anorectal surgery.
Methods: We prospectively assessed preoperative PPT in a cohort undergoing anorectal surgery, known as a moderately to severely painful procedure. Linear mixed-effects models were used to assess the relationship with postoperative VAS pain scores at 1 and 3 days as well as 4 weeks postoperatively. Logistic regression was used to study the relationship with additional postoperative analgesic consumption.
Results: We studied 128 patients and found that preoperative PPT is significantly associated with postoperative pain (P value for interaction = .025). Logistic regression modeling additionally revealed an association between the preoperative PPT and the need for additional postoperative analgesics, with odds of requiring additional analgesia decreasing by about 10% for each 1-point increase in PPT (odds ratio [OR] = 0.90; 95% confidence interval [CI], 00.81–0.98; P = .012).
Conclusions: Preoperative finger PPT is associated with postoperative pain and might help identify patients who are at risk of developing more severe postoperative pain on anorectal surgery. Especially in ambulatory and short-stay settings, this approach can help to address patients’ high variability in pain sensitivity.