Dihle Alfhild, Helseth Sølvi, Kongsgaard Ulf E, Paul Steven M, Miaskowski Christine
Faculty of Nursing, Oslo University College, Oslo, Norway.
J Pain. 2006 Apr;7(4):272-80. doi: 10.1016/j.jpain.2005.11.005.
In the United States, quality improvement (QI) approaches have been used to evaluate pain management. However, the use of QI approaches to evaluate the quality of patient care is just emerging in many European countries. The purposes of this study, using the American Pain Society's QI Standards, were: to describe changes over time, in pain severity, in pain interference with function, and in the doses of analgesics administered; to describe patients' level of satisfaction with postoperative pain management; and to determine the relationships between pain severity and patient outcomes. Results from a sample of patients who underwent orthopedic surgery suggest that undertreatment of pain persists across the first 5 postoperative days and that pain's level of interference with function decreases significantly between the third and fifth postoperative days. As in other studies, despite high pain intensity scores, patients reported high levels of satisfaction with postoperative pain management.
Findings suggest that the undertreatment of pain results in significant decrements in function over the first 5 postoperative days. Future studies designed to improve the quality of postoperative pain management need to use multimodal approaches and evaluate not only pain intensity, but improvements in function as critical outcome measures.
在美国,质量改进(QI)方法已被用于评估疼痛管理。然而,在许多欧洲国家,使用QI方法评估患者护理质量才刚刚兴起。本研究采用美国疼痛协会的QI标准,目的是:描述疼痛严重程度、疼痛对功能的干扰以及所使用镇痛药剂量随时间的变化;描述患者对术后疼痛管理的满意度水平;并确定疼痛严重程度与患者预后之间的关系。对接受骨科手术的患者样本进行的研究结果表明,术后前5天疼痛治疗不足的情况持续存在,且疼痛对功能的干扰程度在术后第3天至第5天之间显著降低。与其他研究一样,尽管疼痛强度评分较高,但患者对术后疼痛管理的满意度较高。
研究结果表明,疼痛治疗不足会导致术后前5天功能显著下降。未来旨在提高术后疼痛管理质量的研究需要采用多模式方法,不仅要评估疼痛强度,还要将功能改善作为关键的结局指标进行评估。