Pain Characteristics after Total Laparoscopic Hysterectomy.
Pain Characteristics after Total Laparoscopic Hysterectomy.
复制标题
总腹腔镜子宫切除术后疼痛特征。
DOI：
10.7150/ijms.15875
复制
发表时间：
2016
影响因子：
3.6
通讯作者：
Kim JE
中科院分区：
文献类型：
--
作者：
Choi JB;Kang K;Song MK;Seok S;Kim YH;Kim JE
背景全腹腔镜子宫切除术（TLH）引起各种类型的术后疼痛，迄今为止尚未详细评估疼痛模式。这项前瞻性观察性研究调查了TLH术后第一个72小时内的术后疼痛类型、随时间推移的强度和疼痛特征。方法.入组了64例接受TLH的女性患者，最终纳入50例患者进行数据分析。疼痛的部位包括全身疼痛、腹部内脏和切口疼痛、肩部疼痛和会阴疼痛。在休息和运动时进行评估，并使用100 mm视觉模拟量表对疼痛水平进行评分。在基线、术后30 min、1 h、3 h、6 h、24 h、48 h和72 h对疼痛进行评估。总体而言，内脏和切口疼痛在手术当天最强烈，然后在手术后减少。相反，肩部疼痛逐渐增加，在术后24小时达到高峰。90%的患者（44/50）出现肩部疼痛。与其他疼痛相比，运动时疼痛并不比休息时更严重，右肩疼痛比左肩疼痛更严重（p=0.006）。此外，患者术前的运动习惯增加了肩痛阈值。大多数患者（46/50）有会阴疼痛，约30%的患者（17/50）的会阴疼痛比腹痛更严重。结论与其他腹腔镜手术相比，TLH后疼痛的持续时间、严重程度和特征有很大不同。肩部疼痛在术后24小时最强烈，其强度与患者先前的运动习惯和高水平的镇痛需求有关。
Background. Total laparoscopic hysterectomy (TLH) causes various types of postoperative pain, and the pain pattern has not been evaluated in detail to date. This prospective observational study investigated the types of postoperative pain, intensity in the course of time, and pain characteristics during the first postoperative 72 hr after TLH. Methods. Sixty four female patients undergoing TLH were enrolled, which finally 50 patients were included for the data analyses. The locations of pain included overall pain, abdominal visceral and incisional pains, shoulder pain, and perineal pain. Assessments were made at rest and in motion, and pain level was scored with the use of the 100 mm visual analog scale. The pain was assessed at baseline, and at postoperative 30 min, 1 hr, 3 hr, 6 hr, 24 hr, 48 hr, and 72 hr. Results. Overall, visceral, and incisional pains were most intense on the day of operation and then decreased following surgery. In contrast, shoulder pain gradually increased, peaking at postoperative 24 hr. Shoulder pain developed in 90% of all patients (44/50). It was not more aggravated in motion than at rest, in comparison with other pains, and right shoulder pain was more severe than left shoulder pain (p=0.006). In addition, the preoperative exercise habit of patients increased the threshold of shoulder pain. Most patients (46/50) had perineal pain, which was more severe than abdominal pain in approximately 30% of patients (17/50). Conclusion. Pain after TLH showed considerably different duration, severity, and characteristics, compared with other laparoscopic procedures. Shoulder pain was most intense at postoperative 24 hr, and the intensity was associated with the prior exercise habit of patients and the high level of analgesic request.