2021年 · 第101卷第14期

About 100 million patients worldwide undergo surgery every year, and more than 60% of them will experience moderate to severe postoperative pain. The increase in acute postoperative pain intensity is associated with the development of postoperative persistent pain (pain that persists more than 3 months after surgery). Previous epidemiology has found that for every 10% increase in the time a patient experiences severe postoperative pain, pain intensity increases by 24% at 6 months after surgery. Therefore, better knowledge of a patient's postoperative pain trajectory may not only affect acute postoperative pain, but also facilitate prophylactic treatment for persistent postoperative pain. In order to establish a better postoperative pain trajectory model to predict the timing of acute and persistent postoperative pain, and thus develop personalized postoperative analgesia protocols, researchers conducted a prospective cohort study at the University of Florida Affiliated Hospital, USA. A total of 360 patients were included in the study after strict admission criteria, and the types of surgery included plastic surgery, urology, colorectal surgery, pancreatic/biliary surgery, thoracic surgery and spinal surgery. Mental health and behavioral factors were measured in the enrolled patients before surgery, and pain scores were performed on days 1 to 7 after surgery using a brief pain scale. Five different postoperative pain trajectory patterns were determined by statistical analysis: (1) the high pain group (58 cases): the youngest group, age (54 ± 12) years, 2/3 women, and the group with the highest proportion of Hispanic population (7%); The types of surgery were evenly distributed in this group, and the demand for opioids within 7 days after surgery and the demand for intraoperative opioids were higher. (2) Moderate to high pain group (167 patients): patients in this group were (58 ± 12) years old, more than 50% were female, more than 10% were black, and 4% were Hispanic; Nearly 1/3 of the patients in this group underwent colorectal surgery; The demand for opioids is higher in the later postoperative period. (3) Mild to moderate pain group (88 cases): patients in this group were (61 ± 13) years old, more than half were male, more than 90% were white, and 5% were Hispanic; All patients were almost evenly distributed in 4 types of surgery: colorectal, plastic, thoracic/cardiovascular, and urological. (4) Mild pain group (25 cases): Compared with other pain trajectory groups, the patients in this group were the oldest, (66 ± 13) years old, 3/4 male, and all patients were non-Hispanic; Nearly 40% of patients in this group underwent colorectal surgery; The mild pain group had the lowest opioid requirement within 7 days after surgery. (5) Pain relief group (22 cases): The patients in this group were similar to those in the mild pain group, and the age was (63±10) years. Nearly 70% are male and not Hispanic; Nearly 1/3 of the patients underwent urological surgery.