Groenewald Cornelius B, Rabbitts Jennifer A, Schroeder Darrell R, Harrison Tracy E
Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Paediatr Anaesth. 2012 Jul;22(7):661-8. doi: 10.1111/j.1460-9592.2012.03807.x. Epub 2012 Feb 15.
Acute pain management in children is often inadequate. The prevalence of pain in hospitalized children in the US is unknown.
We reviewed clinical characteristics of all pediatric patients admitted to Mayo Eugenio Litta Children's hospital during July 2009. Patients with moderate-severe pain were identified. For patients identified as having moderate-severe pain risk factors, analgesia regimens, and pain outcomes were reviewed.
The prevalence of moderate-severe in-hospital pain was 27% (95% C.I. 23% to 32%). Teenagers and infants experienced higher prevalence rates of moderate-severe pain (38% and 32% respectively) than children (17%, P < 0.001). In addition, patients admitted to medical services had much lower rates of moderate-severe pain (13%) than those admitted to surgical services (44%, P < 0.001). Regional anesthesia was used in eleven (7.2%) of the patients on surgical services. Acetaminophen was administered to 75% of patients with moderate-severe pain. Only 21% of these patients had nonsteroidal anti-inflammatory drugs (NSAIDS) available. Opioids were given scheduled to 36% of patients with moderate-severe pain and as needed to another 40%. Fifty-five percent of patients still had one or more episode of moderate-severe pain on the day following an initial diagnosis; however, this number decreased steadily over subsequent days. Eleven patients (13% of those diagnosed with moderate-severe pain) still had one or more episodes of daily moderate-severe pain by day four.
The prevalence of moderate-severe pain in hospitalized children remains high. Analgesia regimens may not be optimal. Underutilization of regional anesthesia techniques may have contributed to increased pain scores. A large proportion of children diagnosed with moderate-severe pain may have persistent clinically significant pain in subsequent days.
儿童急性疼痛管理往往不足。美国住院儿童的疼痛患病率尚不清楚。
我们回顾了2009年7月入住梅奥尤金尼奥·利塔儿童医院的所有儿科患者的临床特征。确定了中度至重度疼痛的患者。对于被确定有中度至重度疼痛风险因素的患者，审查了镇痛方案和疼痛结果。
中度至重度住院疼痛的患病率为27%（95%置信区间为23%至32%）。青少年和婴儿经历中度至重度疼痛的患病率（分别为38%和32%）高于儿童（17%，P<0.001）。此外，入住医疗服务科室的患者中度至重度疼痛发生率（13%）远低于入住外科服务科室的患者（44%，P<0.001）。外科服务科室的11名（7.2%）患者使用了区域麻醉。75%的中度至重度疼痛患者使用了对乙酰氨基酚。这些患者中只有21%可使用非甾体抗炎药（NSAIDS）。36%的中度至重度疼痛患者按计划给予阿片类药物，另有40%按需给予。55%的患者在初次诊断后的第二天仍有一次或多次中度至重度疼痛发作；然而，这一数字在随后几天稳步下降。到第四天，11名患者（占诊断为中度至重度疼痛患者的13%）仍有一次或多次每日中度至重度疼痛发作。
住院儿童中度至重度疼痛的患病率仍然很高。镇痛方案可能并非最佳。区域麻醉技术使用不足可能导致疼痛评分增加。很大一部分被诊断为中度至重度疼痛的儿童在随后几天可能仍有持续的具有临床意义的疼痛。
