麻醉后护理单元中阿片类药物引起的镇静不能确保充分的疼痛缓解：一项病例对照研究。

Opioid-induced sedation in the postanesthesia care unit does not insure adequate pain relief: a case-control study.

作者信息

Lentschener Claude, Tostivint Patrice, White Paul F, Gentili Marc E, Ozier Yves

机构信息

Department of Anesthesia and Critical Care, Université Paris-Descartes, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris Cedex, France.

出版信息

Anesth Analg. 2007 Oct;105(4):1143-7, table of contents. doi: 10.1213/01.ane.0000281441.93304.e3.

DOI:10.1213/01.ane.0000281441.93304.e3

PMID:17898402

Abstract

BACKGROUND

Sedation can occur during intravenous titration of morphine for acute pain control in the postanesthesia care unit (PACU). We designed this case-control study to evaluate the relationship between opioid-induced sedation in the PACU and adequacy of early postoperative analgesia.

METHODS

Intravenous morphine was titrated in 2 mg (body weight < or =60 kg) or 3 mg (body weight >60 kg) boluses every 5 min to treat moderate-to-severe pain in the PACU. Pain was assessed using a 11-point verbal rating scale (VRS) with scores > or =3 representing moderate-to-severe pain. The 6-point Ramsay score was used to assess the level of sedation with scores >3 representing clinically significant sedation. Twenty-six patients, with a Ramsay sedation score >3 and a pain VRS > or =3 at discharge from the PACU, were evaluated 24 h after surgery to assess (a) the recall of early postoperative pain in the PACU, (b) quality of sleep on the first night after surgery, (c) pain on the 24th postoperative hour, and (d) satisfaction with pain management at 24 h after surgery. Two patients discharged from the PACU with VRS pain scores <3 were matched to each of the patients with pain scores > or =3 and Ramsay score >3, as part of a 52 patient control group.

RESULTS

Patients with Ramsay scores >3 and pain scores > or =3 more frequently reported moderate-to-severe pain in the PACU (severe/moderate/no pain: 18%/25%/57% vs 58%/16%/26%, P = 0006, for the control and the sedated group, respectively), poorer quality of sleep the night after surgery (well/moderate/bad: 48%/42%/10% vs 23%/23%/54%, P = 0.001, for the control and the sedated group, respectively), and higher pain scores at the 24th hour after surgery (severe/moderate/no pain: 6%/44%/50% vs 50%/42%/8%, P < 0.0001, for the control and the sedated group, respectively). In addition, their overall satisfaction with pain control during the first 24 postoperative hours was lower (satisfied/moderately satisfied/not satisfied: 96%/2%/2% vs 50%/30%/20%, P < 0.0001, for the control and the sedated group, respectively).

CONCLUSION

Clinically significant opioid-induced sedation in the PACU does not insure adequate self-reported pain relief.

摘要

背景

在麻醉后护理单元（PACU）静脉滴定吗啡以控制急性疼痛期间可能会发生镇静作用。我们设计了这项病例对照研究，以评估PACU中阿片类药物引起的镇静与术后早期镇痛充分性之间的关系。

方法

在PACU中，每5分钟静脉推注2毫克（体重≤60千克）或3毫克（体重>60千克）吗啡，以治疗中度至重度疼痛。使用11分数字评定量表（VRS）评估疼痛，得分≥3表示中度至重度疼痛。采用6分的拉姆齐评分来评估镇静程度，得分>3表示具有临床意义的镇静。26例在PACU出院时拉姆齐镇静评分>3且疼痛VRS评分≥3的患者，在术后24小时进行评估，以评估（a）对PACU中术后早期疼痛的回忆，（b）术后第一晚的睡眠质量，（c）术后第24小时的疼痛情况，以及（d）术后24小时对疼痛管理的满意度。作为52例患者对照组的一部分，从PACU出院时VRS疼痛评分<3的2例患者与每例疼痛评分≥3且拉姆齐评分>3的患者进行匹配。

结果

拉姆齐评分>3且疼痛评分≥3的患者更频繁地报告在PACU中有中度至重度疼痛（严重/中度/无疼痛：分别为18%/25%/57%和58%/16%/26%，对照组和镇静组相比，P = 0.006），术后当晚睡眠质量较差（良好/中度/差：分别为48%/42%/10%和23%/23%/54%，对照组和镇静组相比，P = 0.001），且术后第24小时疼痛评分更高（严重/中度/无疼痛：分别为6%/44%/50%和50%/42%/8%，对照组和镇静组相比，P < 0.0001）。此外，他们对术后前24小时疼痛控制的总体满意度较低（满意/中度满意/不满意：分别为96%/2%/2%和50%/30%/20%，对照组和镇静组相比，P < 0.0001）。