Risk factors for chronic pain after hysterectomy - A nationwide questionnaire and database study
Risk factors for chronic pain after hysterectomy - A nationwide questionnaire and database study
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DOI：
10.1097/01.anes.0000265161.39932.e8
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发表时间：
2007-05-01
期刊：
影响因子：
8.8
通讯作者：
Jensen, Troels S.
中科院分区：
文献类型：
--
作者：
Brandsborg, Birgitte;Nikolajsen, Lone;Jensen, Troels S.
背景资料：因良性指征而计划行子宫切除术的妇女术前经常有盆腔疼痛，但在某些情况下疼痛持续存在或甚至在手术后发展的原因在很大程度上尚不清楚。这项全国性的问卷调查和数据库研究描述了良性适应症子宫切除术后1年的疼痛，并确定了慢性术后疼痛的危险因素。方法：将疼痛问卷邮寄给1,299名子宫切除术后1年的妇女。反应率为90.3%，持续性疼痛的存在与手术指征、手术操作、麻醉类型和其他围手术期数据相关。结果：子宫切除术后1年有31.9%的患者报告疼痛（慢性疼痛），13.7%的患者每周疼痛超过2天。在14.9%的慢性术后疼痛女性中，术前不存在疼痛。慢性疼痛的危险因素是术前盆腔疼痛（比值比[OR]，3.25; 95%置信区间[CI]，2.40-4.41），既往剖宫产（OR，1.54; CI，1.06-2.26），疼痛是手术的主要适应症（OR，2.98; CI，1.54-5.77），其他疼痛问题（OR，3.19; CI，2.294.44）。阴式子宫切除术与经腹全子宫切除术相比，慢性疼痛的风险较低（OR，0.70; CI，0.46-1.06）。重要的是，脊髓麻醉与全身麻醉相比，慢性疼痛较少（OR，0.42; CI，0.21-0.85）。结论：32%的患者在子宫切除术后有慢性疼痛，其危险因素与其他手术中观察到的相似。有趣的是，脊髓麻醉与慢性疼痛的发生频率较低相关，这证明了对慢性术后疼痛风险高的患者进行脊髓麻醉的前瞻性研究。
Background: Women scheduled to undergo hysterectomy for benign indications frequently have preoperative pelvic pain, but it is largely unknown why pain in some cases persists or even develops after surgery. This nationwide questionnaire and database study describes pain and identifies risk factors for chronic postsurgical pain 1 yr after hysterectomy for benign indications. Methods: A pain questionnaire was mailed to 1,299 women 1 yr after hysterectomy. The response rate was 90.3%, and the presence of persistent pain was correlated to indication for surgery, surgical procedure, type of anesthesia, and other perioperative data. Results: Pain was reported by 31.9% 1 yr after hysterectomy (chronic pain), and 13.7% had pain more than 2 days a week. Pain was not present before surgery in 14.9"% of women with chronic postsurgical pain. Risk factors for chronic pain were preoperative pelvic pain (odds ratio [OR], 3.25; 95% confidence interval [CI], 2.40-4.41), previous cesarean delivery (OR, 1.54; Cl, 1.06-2.26), pain as the main indication for surgery (OR, 2.98; CI, 1.54-5.77), and pain problems elsewhere (OR, 3.19; CI, 2.294.44). Vaginal hysterectomy versus total abdominal hysterectomy was not significantly associated with a lower risk of chronic pain (OR, 0.70; CI, 0.46-1.06). Importantly, spinal versus general anesthesia was associated with less chronic pain (OR, 0.42; CI, 0.21-0.85). Conclusions: Thirty-two percent had chronic pain after hysterectomy, and risk factors were comparable to those seen in other operations. Interestingly, spinal anesthesia was associated with a lower frequency of chronic pain, justifying prospective study of spinal anesthesia for patients with a high risk for development of chronic postsurgical pain.