背景:最近的研究表明,抑郁症与足踝手术后持续的术后疼痛和满意度下降有关。本研究旨在评价围手术期应用度洛西汀对抑郁症患者前腓骨韧带(ATFL)修复术后预后的影响。我们进一步寻求评估患者对度洛西汀的满意度和副作用。
方法:使用患者健康问卷(PHQ-9)对接受ATFL修复的患者进行术前抑郁筛查。在249例接受关节镜或开放手术Brostrom修复的ATFL患者中,120名患者被确定为“可能抑郁”,并被纳入研究。60例患者被随机分配到度洛西汀组(术前1天,术后6周),另外60例随机分配到安慰剂组。止痛药和阿片类药物的消费,疼痛评分,在术后12,24,48和72小时以及术后1,3和6个月的随访时记录患者满意度.术前以及术后3、6、12和24个月评估患者报告的结果指标(PROM)。还记录了度洛西汀相关的副作用,例如恶心/呕吐和疲劳。
结果:度洛西汀组的患者报告说,抢救镇痛药的时间明显更长,阿片类药物的需求减少(包括塞来昔布,普瑞巴林,对乙酰氨基酚,和曲马多)。术后24、48、72h及1、3个月患者疼痛强度降低,疼痛管理满意度提高(P<0.05)。与安慰剂组相比,度洛西汀组在随访3个月和6个月时的临床和功能结果也明显更好(P<0.05)。度洛西汀副作用的发生率和症状发生率均无统计学意义。
结论:抑郁症是需要考虑和解决的重要因素,因为手术前抑郁症的存在可以预测术后不良结局,包括更严重的术后疼痛,持续性术后疼痛,止痛药和阿片类药物的消费增加。
结论:抑郁症患者在ATFL修复CAI后的围手术期给予度洛西汀增加了术后首次抢救镇痛要求的时间,并减少了阿片类药物的消耗和术后疼痛。这种方法也导致了高水平的患者满意度。此外,度洛西汀改善了恢复质量,而不会导致明显的副作用。
方法:I;前瞻性随机对照试验。
BACKGROUND: Recent studies have indicated that depression is associated with persistent postoperative pain and decreased satisfaction following foot and ankle surgery. This study aimed to evaluate the effect of perioperative duloxetine on postoperative outcomes of anterior talofibular ligament (ATFL) surgical repair for chronic ankle instability (CAI) in patients with depression. We further sought to evaluate patients\' satisfaction and side effects related to duloxetine.
METHODS: Patients undergoing ATFL repair were screened for depression preoperatively with the Patient Health Questionnaire (PHQ-9). Among 249 patients who underwent arthroscopic or open surgical Brostrom repair of the ATFL, 120 patients were identified as being \"possibly depressed\" and were included in the study. Sixty patients were randomly assigned to the duloxetine group (one day preoperatively and for 6 weeks postoperatively), and the other sixty were randomized to the placebo group. Painkillers and opioid consumption, pain scores, and patient satisfaction were recorded at 12, 24, 48, and 72hours postoperatively and at follow-up visits 1, 3, and 6 months after surgery. Patient-reported outcome measures (PROMs) were assessed preoperatively and at 3, 6, 12 and 24 months postoperatively. Duloxetine-related side effects such as nausea/vomiting and fatigue were also recorded.
RESULTS: The patients in the duloxetine group reported a significantly longer time to rescue analgesic and reduced opioid requirements (including celecoxib, pregabalin, acetaminophen, and tramadol). The patients experienced decreased pain intensity and greater satisfaction with their pain management at 24, 48, 72h and 1 and 3 months after surgery (p<0.05). The duloxetine group also had significantly better clinical and functional outcomes at 3 and 6 months of follow-up compared to the placebo group (p<0.05). The occurrence and rate of symptoms of duloxetine side effects were not significant.
CONCLUSIONS: Depression is an important factor to consider and address because its presence before surgery can predict poor postoperative outcomes, including more severe postoperative pain, persistent postoperative pain, and increased consumption of painkillers and opioids.
CONCLUSIONS: Perioperative administration of duloxetine following ATFL repair for CAI in patients with depression increased the time to first postoperative rescue analgesic request and reduced both opioid consumption and postoperative pain. This approach also led to a high level of patient satisfaction. In addition, duloxetine improved the quality of recovery without leading to significant side effects.
METHODS: I; prospective randomized controlled trial.