Objectives

Post-operative pain is a common clinical problem after surgery, yet its predictors are inconsistent and unclear. This study examined whether pre-surgical vagal cardiac efferent nerve activity, indirectly indexed by heart rate variability (HRV), predicts patients' pain after epileptic surgery.

Methods

Using a prospective design, HRV was measured at rest during 5 min in n = 30 patients, prior to undergoing epileptic surgery. Post-operative pain was assessed every 8 h during the first 2 days after surgery, and our analyses focused on the worse pain level. We used multiple regression analyses and statistically considered several confounders (age, surgical duration, and analgesics during various surgical phases).

Results

Multiple HRV indexes strongly and inversely predicted post-operative pain, with high-frequency HRV (HF-HRV) being the strongest predictor (r = −0.81, p < 0.001). In a hierarchical multiple regression, HF-HRV accounted for an additional and significant 18% of the variance in post-operative pain, after statistically considering effects of age, surgical duration and effects of two anaesthetics.

Conclusions

Pre-surgical HF-HRV independently, strongly and inversely predicts post-operative pain. These results are in line with a neuromodulatory role of the vagus nerve in pain and have clinical implications for predicting and managing post-operative pain.

中文翻译：

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手术前心率变异性强烈预测癫痫患者术后疼痛减轻

目标

术后疼痛是术后常见的临床问题，但其预测因素不一致且不清楚。这项研究检查了术前迷走神经心脏传出神经活动（由心率变异性 (HRV) 间接指示）是否可以预测癫痫手术后患者的疼痛。

方法

使用前瞻性设计，在 接受癫痫手术前，n = 30 名患者在 5 分钟内在休息时测量 HRV 。在手术后的前 2 天内每 8 小时评估一次术后疼痛，我们的分析集中在更严重的疼痛程度。我们使用多元回归分析并统计考虑了几个混杂因素（年龄、手术持续时间和不同手术阶段的镇痛药）。

结果

多个 HRV 指数强烈和反向预测术后疼痛，高频 HRV (HF-HRV) 是最强的预测因子 ( r  = -0.81, p  < 0.001)。在分层多元回归中，在统计考虑年龄、手术持续时间和两种麻醉剂效果的影响后，HF-HRV 占术后疼痛变异的额外且显着的 18%。

结论

术前 HF-HRV 独立、强烈和反向预测术后疼痛。这些结果与迷走神经在疼痛中的神经调节作用一致，并且对预测和管理术后疼痛具有临床意义。