Vallano A, Aguilera C, Arnau J M, Baños J E, Laporte J R
Fundació Institut Català de Farmacologia, Hospitals Vall d'Hebron, Barcelona, Spain.
Br J Clin Pharmacol. 1999 Jun;47(6):667-73. doi: 10.1046/j.1365-2125.1999.00962.x.
Postoperative pain is common in hospital-admitted patients. Its management is determined by different therapeutic traditions and by the attitudes of health professionals in each hospital. The aim of this study was to describe the patterns of prescription and administration of analgesic drugs used for postoperative pain after abdominal surgery in Spanish hospitals, to know the prevalence and the severity of postoperative pain, and to determine the extent of variability in the management of postoperative pain among the participating centres.
The study was a multicentre descriptive cross-sectional drug utilization study in 12 Spanish hospitals. The subjects were an unselected sample of consecutive patients undergoing abdominal surgery, admitted between October 1994 and January 1995. For each patient, information about the surgical procedure and the use of analgesics was prospectively collected. The severity of postoperative pain was assessed during the first day after surgery by means of a six-category (none, mild, moderate, severe, very severe, and unbearable) rating scale and a visual analogue scale (VAS).
Nine hundred and ninety-three patients (547 men) were included. The most common surgical procedures were inguinal hernia repair (315, 32%), cholecystectomy (268, 27%), appendectomy (140, 14%), bowel resection (137, 14%), and gastric surgery (58, 6%). Fifty-nine percent of patients (587) received nonopioid analgesics only, 9% (89) received opioid analgesics only, and 27% (263) received both opioid and nonopioid analgesics. The most frequently administered drugs were metamizole (667 patients) and pethidine (213 patients). Although in the majority of medical orders the administration of analgesics was scheduled at regular time intervals, the majority of actual doses were given 'as-needed'. The average administered daily doses of all analgesics were lower than those prescribed. Thirty-eight percent (371/967) of patients rated their maximum pain on the first day as severe to unbearable. Wide interhospital variability was recorded in the surgical procedures which had been performed, in the analgesics used, and also in the pain scores referred by patients. The percentage of patients in each centre who suffered severe to unbearable pain varied from 22 to 67%.
In Spain many patients still suffer severe pain after abdominal surgery, and this seems to be due to an inadequate use of analgesics. Wide interhospital variability in the management of postoperative pain and in its prevalence was also recorded.
术后疼痛在住院患者中很常见。其管理方式取决于不同的治疗传统以及各医院医护人员的态度。本研究的目的是描述西班牙医院腹部手术后用于术后疼痛的镇痛药的处方和使用模式，了解术后疼痛的发生率和严重程度，并确定参与研究的各中心在术后疼痛管理方面的差异程度。
该研究是一项在12家西班牙医院开展的多中心描述性横断面药物利用研究。研究对象为1994年10月至1995年1月期间连续接受腹部手术的未经过筛选的患者样本。对于每位患者，前瞻性收集有关手术过程和镇痛药使用情况的信息。术后第一天通过六类（无、轻度、中度、重度、非常重度和无法忍受）评定量表和视觉模拟量表（VAS）评估术后疼痛的严重程度。
共纳入993例患者（547例男性）。最常见的手术是腹股沟疝修补术（315例，32%）、胆囊切除术（268例，27%）、阑尾切除术（140例，14%）、肠切除术（137例，14%）和胃部手术（58例，6%）。59%的患者（587例）仅接受非阿片类镇痛药，9%（89例）仅接受阿片类镇痛药，27%（263例）同时接受阿片类和非阿片类镇痛药。最常使用的药物是安乃近（667例患者）和哌替啶（213例患者）。尽管在大多数医嘱中镇痛药是按固定时间间隔给药，但大多数实际剂量是“按需”给予的。所有镇痛药的平均每日给药剂量低于处方剂量。38%（371/967）的患者将术后第一天的最大疼痛评为重度至无法忍受。在已实施的手术、使用的镇痛药以及患者报告的疼痛评分方面，各医院之间存在很大差异。各中心中遭受重度至无法忍受疼痛的患者比例从22%到67%不等。
在西班牙，许多患者腹部手术后仍遭受严重疼痛，这似乎是由于镇痛药使用不当所致。在术后疼痛管理及其发生率方面，各医院之间也存在很大差异。
