Bell Jeffrey G, Shaffer Lynn E T, Schrickel-Feller Trista
Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Columbus, OH, USA.
Am J Obstet Gynecol. 2007 Nov;197(5):472.e1-7. doi: 10.1016/j.ajog.2007.03.039.
The objective of the study was to determine whether any of 3 routes of opioid administration (patient-controlled analgesia [PCA], scheduled intermittent intravenous [i.v.], or scheduled intermittent subcutaneous [s.q.]) provides superior pain relief and satisfaction among patients undergoing abdominal gynecologic surgery.
Patients were randomized to intravenous hydromorphone by PCA, i.v. hydromorphone via scheduled nurse-administered doses, or s.q. hydromorphone via scheduled nurse-administered doses. Self-reported pain and satisfaction were recorded over 48 hours following arrival at the nursing unit. Linear mixed effects modeling was used to compare outcomes among the groups.
Neither pain scores nor satisfaction differed by group. PCA patients had higher total opioid use (P < .0001) and a higher rate of pruritus (P = .04).
Given these findings as well as those in previous literature, no specific method of postoperative analgesia appears to be superior.
本研究的目的是确定三种阿片类药物给药途径（患者自控镇痛[PCA]、定时间歇性静脉注射[i.v.]或定时间歇性皮下注射[s.q.]）中的任何一种，是否能为接受腹部妇科手术的患者提供更好的疼痛缓解和满意度。
患者被随机分为通过PCA静脉注射氢吗啡酮组、由护士按预定剂量静脉注射氢吗啡酮组或由护士按预定剂量皮下注射氢吗啡酮组。到达护理单元后的48小时内记录患者自我报告的疼痛和满意度。使用线性混合效应模型比较各组间的结果。
各组间疼痛评分和满意度均无差异。PCA患者的阿片类药物总用量更高（P < .0001），瘙痒发生率更高（P = .04）。
鉴于这些发现以及先前文献中的发现，似乎没有哪种特定的术后镇痛方法更具优势。
