Chronic pain and sensory changes after augmentation mammoplasty: Long term effects of preincisional administration of methylprednisolone
Chronic pain and sensory changes after augmentation mammoplasty: Long term effects of preincisional administration of methylprednisolone
复制标题
DOI：
10.1016/j.pain.2006.03.020
复制
发表时间：
2006-09-01
期刊：
影响因子：
7.4
通讯作者：
Stubhaug, Audun
中科院分区：
文献类型：
--
作者：
Romundstad, Luis;Breivik, Harald;Stubhaug, Audun
我们研究了美容隆髓成形术后慢性疼痛和长期感觉变化的患病率以及单次静脉注射的效果。术前剂量甲基强的松龙125 mg(n=74)、帕瑞昔布40 mg(n=71)或安慰剂(n=74)。术后6周和1年后邮寄调查问卷。1年后有效率为80%。1年时，13%的患者出现非诱发性疼痛，20%的患者出现诱发性疼痛，两组间无统计学差异。与安慰剂(56%，P<；0.01)和帕瑞昔布(51%，P<；0.04)相比，甲基强的松龙降低了1年后感觉过敏的发生率(OR 0.3，95%CI 0.1-0.6)，并显著降低了感觉过敏的发生率(30%，P<；0.01)。术后1年疼痛风险增加的相关因素为术后6天疼痛强度(OR 1.3，95%CI 1.1~1.6)、术后6周疼痛(OR 18.4，95%CI 6.9~49.3)、术后6周感觉过敏(OR 2.3，95%CI 1.1~5.1)和目前感觉过敏(OR 3.1，95%CI 1.4~6.7)。我们得出的结论是，隆乳术后持续疼痛和感觉改变是常见的，患者在6周时有疼痛，很可能在1年后也会有疼痛。术后急性疼痛、6周感觉过敏和感觉过敏的存在增加了1年后疼痛的几率。与帕瑞昔布和安慰剂相比，术前甲基强的松龙导致的感觉过敏显著减少，但并未显著降低持续性自发或诱发疼痛的发生率。(C)2006年国际疼痛研究协会。爱思唯尔出版，版权所有。
We studied the prevalence of chronic pain and long term sensory changes after cosmetic augmentation marnmoplasty and the effects of a single i.v. preoperative dose of methylprednisolone 125 mg (n = 74), parecoxib 40 mg (n = 71), or placebo (n = 74). A questionnaire was mailed 6 weeks and I year after surgery. Response rate after I year was 80%. At I year non-evoked pain was present in 13%, and evoked pain was present in 20% with no statistically significant differences between the groups. Methylprednisclone was associated with reduced odds for hyperesthesia at 1 year (OR 0.3, 95% CI 0.1-0.6), and significantly reduced the prevalence of hyperesthesia (30%) compared with placebo (56%, P < 0.01) and parecoxib (51%, P < 0.04). Factors associated with increased odds for pain at 1 year were intensity of pain during the first 6 days after surgery (OR 1.3, 95% CI 1.1-1.6), pain at 6 weeks (OR 18.4, 95% CI 6.9-49.3), hyperesthesia at 6 weeks (OR 2.3, 95% Cl 1.1-5.1) and present hyperesthesia (OR 3.1, 95% CI 1.4-6.7). We conclude that persistent pain and sensory changes are common after augmentation mammoplasty, and that patients having pain at 6 weeks most likely will have pain also at 1 year. Acute postoperative pain, hyperesthesia at 6 weeks, and the presence of hyperesthesia increased the odds for pain at 1 year. Preoperative methylprednisolone resulted in significantly less hyperesthesia compared with both parecoxib and placebo, but did not significantly reduce the prevalence of persistent spontaneous or evoked pain. (c) 2006 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.