从疼痛程度到疼痛体验：重新定义急性疼痛评估，加深对慢性术后疼痛的理解。

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2024-09-26 DOI:10.1016/j.bja.2024.08.003

Axel Maurice-Szamburski , Sophie Bringuier , Pascal Auquier , Xavier Capdevila

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引用次数: 0

摘要

背景：慢性手术后疼痛（CPSP）严重影响患者的生活质量，并对医疗保健造成巨大负担，多达四分之一的手术患者会受到影响。虽然急性疼痛被认为是 CPSP 发生的一个预测因素，但患者经历所起的作用仍未得到充分探讨。本研究除了探讨骨科手术后 CPSP 的传统风险因素外，还探讨了患者体验的预测价值。方法对一项多中心随机临床试验中的 294 名患者进行了探索性分析，该试验比较了非卧床骨科手术中的连续硬膜外镇痛和单次注射神经阻滞。患者体验采用 Evaluation du Vecu de l'Anesthésie Générale (EVAN-G) 验证问卷进行评估。结合患者报告的结果和经典变量，通过单变量和多变量分析确定了与术后90天CPSP相关的因素。多变量分析显示，术后第 2 天以 EVAN-G 疼痛维度评估的不良疼痛体验是 CPSP 的独立预测因素（几率比 6.45，95% 置信区间 1.65-25.26，P<0.01）。结论：本研究强调了患者报告的结果，特别是 EVAN-G 量表所反映的疼痛体验维度在预测术后 90 天 CPSP 中的作用。该研究建议从传统的疼痛强度评估转向对疼痛体验的全面了解，提倡采用量身定制的疼痛管理方法，以减少慢性疼痛，从而改善患者的生活质量和功能恢复。

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From pain level to pain experience: redefining acute pain assessment to enhance understanding of chronic postsurgical pain

Background

Chronic postsurgical pain (CPSP) significantly impairs quality of life and poses a substantial healthcare burden, affecting up to a quarter of patients undergoing surgery. Although acute pain is recognised as a predictor for CPSP development, the role of patient experience remains underexplored. This study examines the predictive value of patient experience alongside traditional risk factors for CPSP after orthopaedic surgery.

Methods

An exploratory analysis was conducted on 294 patients from a multicentre randomised clinical trial comparing continuous perineural analgesia and single-injection nerve block in ambulatory orthopaedic surgeries. Patient experience was assessed using the Evaluation du Vecu de l’Anesthésie Générale (EVAN-G) validated questionnaire. Factors associated with CPSP at 90 days after surgery were identified through univariate and multivariate analyses, incorporating patient-reported outcomes and classical variables.

Results

Out of 219 patients with complete data, 63 (29%) developed CPSP at day 90. Multivariate analysis revealed a poor pain experience, as assessed by the pain dimension of EVAN-G on postoperative day 2, as an independent predictor of CPSP (odds ratio 6.45, 95% confidence interval 1.65–25.26, P<0.01). Poor pain experience was associated with an augmented risk of CPSP.

Conclusions

This study underscores the role of patient-reported outcomes, specifically the pain experience dimension captured by the EVAN-G scale, in prediction of CPSP 90 days after surgery. It suggests a shift from conventional assessments of pain intensity to a comprehensive understanding of pain experience, advocating for tailored pain management approaches that could reduce chronic pain, thereby improving patient quality of life and functional recovery.

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.