Department of Anaesthesiology, Intensive Care and Pain Management, St Antonius Hospital, Nieuwegein, The Netherlands.
Eur J Anaesthesiol. 2010 Oct;27(10):900-5. doi: 10.1097/eja.0b013e32833d91c3.
Although clinical guidelines recommend systematic evaluation of pain in ICU patients, we know little about the effects from such systematic pain evaluation. This study aims to quantify the effect of a pain management programme in the ICU.
In this prospective two-phase study, pain levels scored by ICU patients after cardiac surgery through sternotomy were compared before and after the implementation of a pain management programme. The pain management programme consisted of a three-fold strategy; all staff was trained in assessing pain and in providing adequate analgesia, a new patient data management system obliged nurses to ask patients for their pain score three times a day and the preferred analgesic treatment was optimised. The numeric rating scale (NRS 0-10) was used by 190 patients. A NRS at least 4 was considered unacceptable. A generalised linear mixed-effects model was used for analysing repeated measurements data.
The occurrence of unacceptable pain (NRS > or = 4) was significantly lower in the intervention group [odds ratio 2.54 (95% confidence interval 1.22-5.65; P = 0.01) for the control group]. Patients in the intervention group received significantly more morphine (29.3 vs. 22.6 mg a day, P<0.01), with higher morphine amounts administered to patients with higher NRS scores (P = 0.01). In the control group, no such relationship was observed (P = 0.66). There was no difference in length of stay in the ICU or in ventilation time.
The intervention programme successfully reduced the occurrence of unacceptable pain. Further improvement of pain management should focus on the prevention of pain.
尽管临床指南建议对 ICU 患者进行系统的疼痛评估，但我们对这种系统疼痛评估的效果知之甚少。本研究旨在量化 ICU 中疼痛管理计划的效果。
在这项前瞻性的两阶段研究中，通过胸骨切开术对心脏手术后 ICU 患者的疼痛程度进行了评分，比较了疼痛管理计划实施前后的疼痛程度。疼痛管理计划包括三重策略；所有工作人员都接受了评估疼痛和提供足够镇痛的培训，新的患者数据管理系统要求护士每天询问患者三次疼痛评分，并且优化了首选的镇痛治疗。190 名患者使用数字评分量表（NRS 0-10）。NRS 至少为 4 被认为是不可接受的。使用广义线性混合效应模型分析重复测量数据。
干预组不可接受疼痛（NRS ≥ 4）的发生率显著降低[对照组的比值比为 2.54（95%置信区间 1.22-5.65；P = 0.01）]。干预组患者接受的吗啡明显更多（29.3 与 22.6 mg/天，P<0.01），NRS 评分较高的患者接受的吗啡量也较高（P = 0.01）。在对照组中，未观察到这种关系（P = 0.66）。两组患者在 ICU 住院时间或通气时间方面无差异。
干预计划成功降低了不可接受疼痛的发生率。进一步改善疼痛管理应侧重于预防疼痛。
