Svensson I, Sjöström B, Haljamäe H
Departments of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden.
J Pain Symptom Manage. 2000 Sep;20(3):193-201. doi: 10.1016/s0885-3924(00)00174-3.
Pain in the postoperative period has remained a clinical problem in spite of major progress in pain assessment and management. The aim of the present study was to describe in detail the time course of pain experiences of surgical patients (n=200) following elective surgical procedures. Visual analogue scale (VAS, 0-100 mm) was used for pain intensity ratings at 4, 24, 48, and 72 hours after surgery. Interviews were carried out to assess the occurrence of intermittent worst pain episodes during each 24-hour period and to relate such experiences to clinical events. At 4, 24, 48, and 72 hours postoperatively, 39%, 43%, 27%, and 16% of the patients, respectively, experienced moderate or even severe pain (VAS > or =40 mm) at rest. During the first 24 hours after surgery, 88% of the patients had experienced moderate or severe pain at some time (VAS > or =40 mm). Corresponding figures for the following 24 hour periods were 81% and 72%, respectively. Spontaneous pain breakthrough and movement/mobilization were identified as reasons for the worst pain episodes during the first 72-hour period after surgery. The probability of pain intensity of VAS >40 mm was calculated from individual regression functions. The probability was found to be much higher for patients receiving parenteral analgesics than for patients receiving prolonged epidural analgesia. Despite major improvements in pain assessment and management, postoperative patients often experience moderate to severe pain, and worst pain episodes occur even in the late postoperative phase. The present study emphasizes that in the clinical routine management of pain, further quality assurance efforts are necessary.
尽管在疼痛评估和管理方面取得了重大进展，但术后疼痛仍然是一个临床问题。本研究的目的是详细描述择期手术患者（n = 200）术后疼痛经历的时间进程。使用视觉模拟量表（VAS，0 - 100 mm）对术后4、24、48和72小时的疼痛强度进行评分。进行访谈以评估每个24小时期间间歇性最严重疼痛发作的发生情况，并将这些经历与临床事件相关联。术后4、24、48和72小时，分别有39%、43%、27%和16%的患者在休息时经历中度甚至重度疼痛（VAS≥40 mm）。在术后的第一个24小时内，88%的患者在某个时间经历过中度或重度疼痛（VAS≥40 mm）。接下来的24小时期间相应的数字分别为81%和72%。自发疼痛发作和活动/移动被确定为术后前72小时内最严重疼痛发作的原因。通过个体回归函数计算VAS>40 mm的疼痛强度概率。发现接受胃肠外镇痛药的患者比接受长时间硬膜外镇痛的患者概率要高得多。尽管在疼痛评估和管理方面有了重大改进，但术后患者经常经历中度至重度疼痛，即使在术后晚期也会出现最严重疼痛发作。本研究强调，在疼痛的临床常规管理中，需要进一步进行质量保证工作。
