Frigon Chantal, Loetwiriyakul Witthaya, Ranger Manon, Otis Annik
Department of Anesthesiology, McGill University Health Center, Montreal Children's Hospital, Montreal, QC, Canada.
Paediatr Anaesth. 2009 Dec;19(12):1213-9. doi: 10.1111/j.1460-9592.2009.03184.x. Epub 2009 Oct 23.
A continuous epidural infusion of morphine is the pain treatment modality for children undergoing selective dorsal rhizotomy (SDR) in our institution. The aim of the study was to evaluate the impact of having an organized acute pain service (APS) on postoperative pain management of these children.
We conducted a retrospective cohort study using anesthetic records and the APS database to compare the postoperative pain management of children undergoing SDR before and after the introduction of the APS at the Montreal Children's Hospital in April 2001. Ninety-two consecutive children who had their surgery between January 1997 and July 2006 were included. We collected data regarding postoperative pain, opioid-induced side effects, complications (sedation, desaturations < 92%), and hospital length of stay.
Pain scores were documented more frequently after the implementation of the APS (61% vs 48.5%). Sedation scores were documented only after the implementation of the APS. Postoperative desaturation was significantly more frequent in the pre-APS group compared to the APS group (45.5% vs 6.8%, P < 0.001). Despite the fact that the epidural catheter was in place for the same duration for both groups [median of 3 days (3-3 25-75%ile)], the duration of hospitalization was 1 day shorter in the APS group compared to the pre-APS group [median of 5 (5-5 25-75%ile) vs 6 (5-6 25-75%ile) days, P < 0.001].
Although we recognize that it is possible that there were changes in care not related specifically to the introduction of a dedicated APS that occurred in our institution that resulted in improvements in general postoperative care and in length of stay, our study did show that having an organized APS allowed to significantly decrease the incidence of postoperative oxygen desaturation and to decrease the hospital length of stay by 1 day.
在我们机构中，持续硬膜外输注吗啡是接受选择性背根切断术（SDR）儿童的疼痛治疗方式。本研究的目的是评估建立有组织的急性疼痛服务（APS）对这些儿童术后疼痛管理的影响。
我们进行了一项回顾性队列研究，使用麻醉记录和APS数据库，比较2001年4月蒙特利尔儿童医院引入APS前后接受SDR儿童的术后疼痛管理情况。纳入了1997年1月至2006年7月期间连续接受手术的92名儿童。我们收集了有关术后疼痛、阿片类药物引起的副作用、并发症（镇静、饱和度<92%）和住院时间的数据。
实施APS后疼痛评分记录更频繁（61%对48.5%）。仅在实施APS后才有镇静评分记录。与APS组相比，APS前组术后饱和度明显更高（45.5%对6.8%，P<0.001）。尽管两组硬膜外导管留置时间相同[中位数为3天（第25-75百分位数为3-3）]，但APS组住院时间比APS前组短1天[中位数为5天（第25-75百分位数为5-5）对6天（第25-75百分位数为5-6），P<0.001]。
虽然我们认识到可能存在与我们机构引入专门的APS无关的护理变化，这些变化导致了总体术后护理和住院时间的改善，但我们的研究确实表明，建立有组织的APS可显著降低术后氧饱和度降低的发生率，并使住院时间缩短1天。
