McGrath Brid, Elgendy Hany, Chung Frances, Kamming Damon, Curti Bruna, King Shirley
Department of Anesthesia, EC 2-046, Toronto Western Hospital, 399 Bathurst St., Toronto, Ontario M5T 2S8, Canada.
Can J Anaesth. 2004 Nov;51(9):886-91. doi: 10.1007/BF03018885.
Postoperative pain is the commonest reason for delayed discharge and unanticipated hospital admission after ambulatory surgery. We investigated the severity of pain at 24 hr postoperatively and determined the most painful procedures. The need for further medical advice and clarity of postoperative analgesia instructions were also studied.
Five thousand seven hundred and three ambulatory surgical patients were telephoned 24 hr postoperatively. Patients graded their pain using the ten-point self-assessing verbal scale (0 = no pain, 10 = worst pain). Data were analyzed in two groups, those with moderate to severe pain (pain score 4-10) and those with no or mild pain (0-3).
Thirty percent of patients (1,495/5,703) had moderate to severe pain. Microdiscectomy, laparoscopic cholecystectomy, shoulder surgery, elbow/hand surgery, ankle surgery, inguinal hernia repair, and knee surgery were identified as the procedures causing most pain at 24 hr. 13.2% of patients needed medical advice by telephone, 1.4% made an unplanned visit to a doctor while the rate of readmission to the hospital was 0.08%. Ninety-eight percent found postoperative instruction sheets and advice helpful. Eighty-eight percent of patients indicated that analgesic instructions were absolutely clear.
This study has identified the more painful common ambulatory surgical procedures which will allow take home analgesia to be tailored according to individual procedures. Further improvement in analgesic instructions may help in better pain management of ambulatory surgery patients.
术后疼痛是门诊手术后延迟出院和意外入院的最常见原因。我们调查了术后24小时的疼痛严重程度，并确定了最疼痛的手术。还研究了进一步寻求医疗建议的必要性以及术后镇痛说明的清晰度。
对5703例门诊手术患者在术后24小时进行电话随访。患者使用十点自我评估语言量表对疼痛进行分级（0 = 无疼痛，10 = 最剧烈疼痛）。数据分为两组进行分析，即中度至重度疼痛组（疼痛评分4 - 10）和无疼痛或轻度疼痛组（0 - 3）。
30%的患者（1495/5703）有中度至重度疼痛。显微椎间盘切除术、腹腔镜胆囊切除术、肩部手术、肘部/手部手术、踝关节手术、腹股沟疝修补术和膝关节手术被确定为术后24小时引起最疼痛的手术。13.2%的患者需要通过电话寻求医疗建议，1.4%的患者进行了非计划的就医，而再入院率为0.08%。98%的患者认为术后说明书和建议有帮助。88%的患者表示镇痛说明绝对清晰。
本研究确定了更疼痛的常见门诊手术，这将有助于根据个体手术定制带回家的镇痛方案。镇痛说明的进一步改进可能有助于更好地管理门诊手术患者的疼痛。
