△通讯作者:黄枭,邮箱:[e-mail]

The effect of patient-controlled analgesia on chronic postoperative pain in patients undergoing anorectal surgery

摘要:

目的： 研究患者自控静脉镇痛（Patient Controlled Analgesia,?PCA）对肛肠手术患者术后慢性疼痛的影响。方法： 拟前瞻性收集2019年8月-2021年10月北京市肛肠医院行择期肛肠手术患者 800例，根据患者是否有PCA将患者分为PCA组和非PCA组，收集两组患者围术期临床资料，包括基线临床资料、术中麻醉和手术相关数据及术后急性和慢性疼痛指标，此外还将记录患者恶心、呕吐、住院时间和患者满意度情况等。结果： 最终纳入患者746例。其中肛瘘357例，PPH259例，外剥内扎122例，肛裂8例。麻醉方式中，骶麻、腰麻、全麻病例分别为368、291、87例。根据患者术毕是否有PCA分为PCA组和非PCA组，其中PCA组345例，非PCA组401例，两组基线临床资料未见明显差异。非PCA组与PCA组术后3个月疼痛发生率分别为5.8%和4.0%，两组比较没有显著差异（P=0.235，调整后OR（95%CI）=1.51（0.77-2.96））。非PCA组与PCA组术后6个月疼痛发生率为1.2%和0.7（P=0.566，调整后OR（95%CI）=1.55（0.35-6.99））。与非PCA组相比，PCA组术后锐痛、灼烧样疼痛、坠胀、持续1个月以上的疼痛发生率显著降低（P<0.05）；PCA组术后1至7天静息VAS评分较非PCA组均显著降低（P<0.05）。PCA术后恶心和呕吐发生率较非PCA组无明显差异。PCA组术后睡眠干扰率较非PCA组显著降低（8.0%vs16.3%，P=0.001,调整后OR（95%CI）=2.26（1.42-3.58））。PCA组术后患者满意度较非PCA组显著增加（P＜0.05）。两组住院时间比较差异无统计学意义。结论： 本研究表明PCA不能改善肛肠术后慢性疼痛，但能显著减少术后急性疼痛，提高患者睡眠质量和患者满意度。

Abstract:

Objective：To study the effect of patient-controlled analgesia (PCA) on postoperative chronic pain in patients undergoing anorectal surgery. Methods：Eight hundred patients undergoing elective anorectal surgery in Beijing Rectum Hospital during August 2019-October 2021 were prospectively collected. Patients were divided into PCA and non-PCA groups according to whether they received PCA or not. Clinical data were collected from both groups, including baseline clinical data, intraoperative anesthesia and surgery-related data, and postoperative acute and chronic pain indicators. Results：Seven?hundred?and?forty-six patients were finally included. Among them, 357 were anal fistulas, 259 were PPH, 122 were external stripping and internal ligation, and 8 were anal fissures. There were 368, 291 and 87 cases received sacral, lumbar and general anesthesia, respectively. No significant differences were found in the baseline clinical data between the PCA group (n=345) and the non-PCA group (n=401). The incidence of pain at 3 months postoperatively was 5.8% and 4.0% in the non-PCA and PCA groups, respectively (P=0.235, adjusted OR (95% CI)=1.51 (0.77-2.96)). The incidence of pain at 6 months postoperatively was 1.2% and 0.7 in the non-PCA group versus the PCA group (P=0.566, adjusted OR (95% CI) = 1.55 (0.35-6.99)). The risk of postoperative sharp pain, burning-like pain, cramping, and pain lasting more than 1 month was significantly lower in the PCA group compared with the non-PCA group (P<0.05). VAS scores at rest from 1 to 7 days postoperatively were significantly lower in the PCA group compared with the non-PCA group (P<0.05). The incidence of postoperative nausea and vomiting was not significantly different in the PCA compared with the non-PCA group. There was a significant decrease in postoperative sleep disturbance in the PCA group compared with the non-PCA group (8.0% vs. 16.3%, P=0.001, adjusted OR (95% CI) = 2.26 (1.42-3.58)). Postoperative patient satisfaction was significantly increased in the PCA group compared with the non-PCA group (P<0.05). There was no statistically significant difference in the length of hospital stay between the two groups. Conclusion：This study showed that PCA did not improve chronic postoperative anal pain, but significantly reduced acute postoperative pain and improved patient sleep quality and patient satisfaction.