Snell Pamela, Hicks Carolyn
Birmingham Women's Hospital, Metchley Park Road, Edgbaston, Birmingham, UK.
Midwifery. 2006 Sep;22(3):249-61. doi: 10.1016/j.midw.2005.08.005. Epub 2005 Dec 13.
To compare the effects of three types of analgesic administration after elective caesarean section on a number of clinical outcome measures. Supplementary aims of the study were to determine the acceptability of, and satisfaction with, the different regimens.
A quasi-experimental different subject design was used to compare three types of analgesic administration on pain, post-operative nausea and vomiting, analgesic consumption, length of hospital stay and overall satisfaction with pain management.
A specialist women's hospital in a large UK city, with around 1500 caesarean sections per annum.
95 women who had undergone elective caesarean section.
The women were allocated to one of the three pain management groups: group 1 (oral morphine, Co-dydramol and diclofenac [all self-administered]); group 2 (oral morphine, Co-dydramol and diclofenac [all midwife-administered]); and Group 3 (intra-muscular morphine, oral Co-dydramol and diclofenac [all midwife-administered]). The safety of self-medication was measured by adherence to a safety protocol.
Data collection was undertaken over the first 3 days after surgery and included visual analogue scale (0-100mm) pain scores, analgesic consumption, incidence of post-operative nausea and vomiting, and length of hospital stay. In addition, questionnaires were given to midwives and patients to assess the acceptability of self-medication and patient satisfaction. Data collection took place between June 2002 and June 2003.
The results indicated that the outcomes of all three interventions were comparable in terms of pain scores, incidence of post-operative nausea and vomiting, and overall levels of satisfaction, although intra-muscular morphine was disliked to a degree that deterred some women from requesting it. Consumption of oral morphine was significantly greater than consumption of intramuscular injections of morphine, whereas Co-dydramol use was lower in the self-medicating group; the self-medicating women also went home, on average, a day earlier than women in the other two groups.
比较择期剖宫产术后三种镇痛给药方式对多项临床结局指标的影响。该研究的补充目的是确定不同给药方案的可接受性和患者满意度。
采用准实验性不同受试者设计，比较三种镇痛给药方式对疼痛、术后恶心呕吐、镇痛药物用量、住院时间以及疼痛管理总体满意度的影响。
英国一座大城市的一家专业妇产医院，每年约有1500例剖宫产手术。
95例行择期剖宫产手术的女性。
将这些女性分为三个疼痛管理组之一：第1组（口服吗啡、双氯芬酸二乙胺和双氯芬酸[均为患者自行给药]）；第2组（口服吗啡、双氯芬酸二乙胺和双氯芬酸[均由助产士给药]）；第3组（肌肉注射吗啡、口服双氯芬酸二乙胺和双氯芬酸[均由助产士给药]）。通过遵守安全协议来衡量自我给药的安全性。
在术后头3天进行数据收集，包括视觉模拟量表（0 - 100mm）疼痛评分、镇痛药物用量、术后恶心呕吐发生率以及住院时间。此外，向助产士和患者发放问卷，以评估自我给药的可接受性和患者满意度。数据收集于2002年6月至2003年6月期间进行。
结果表明，在疼痛评分、术后恶心呕吐发生率和总体满意度方面，所有三种干预措施的效果相当，尽管肌肉注射吗啡在一定程度上不受欢迎，导致一些女性不愿要求使用。口服吗啡的用量显著高于肌肉注射吗啡的用量，而在自我给药组中双氯芬酸二乙胺的用量较低；自我给药的女性平均比其他两组女性早一天出院。
