Lemoyne S, De Paepe P, Vankeirsbilck C, Buylaert W
Emergency Department, University Hospital Ghent, Ghent, Belgium.
Acta Clin Belg. 2011 Nov-Dec;66(6):405-9. doi: 10.2143/ACB.66.6.2062603.
Improving pain management in the ED might be attained by adequate teaching of medical students. We assessed the skills in pain treatment of ED physicians who teach the students.
All physicians working in an ED who provide elective training to undergraduate medical students from the Ghent University were asked to complete a questionnaire consisting of vignette patient cases concerning acute pain management of abdominal colic pain, and non-traumatic abdominal pain.
Thirty two physicians completed the cases. In the renal colic case 91% of the respondents proposed a NSAID as first line treatment. Butylhyoscine was still suggested by 18%. After initial failure of analgesia 31% administered a strong opioid. In biliary colic pain NSAIDs and butylhyoscine were proposed as first line analgesics by 59% and 31% respectively. In second line, butylhyoscine would be given by 22%. The patient case with right fossa abdominal pain would initially be treated with acetaminophen by 81%. Thirteen % of the respondents would not give further analgesia if the first line treatment was insufficient.
Our results indicate that adherence by teachers to evidence based guidelines of acute pain management is insufficient. Therefore improving knowledge and skills in pain management of the teachers should receive more attention.
通过对医学生进行充分的教学，或许能够改善急诊科的疼痛管理。我们评估了教授学生的急诊科医生在疼痛治疗方面的技能。
所有在急诊科工作且为根特大学本科医学生提供选修培训的医生，均被要求完成一份问卷，问卷包含有关腹部绞痛和非创伤性腹痛急性疼痛管理的病例 vignette。
32 名医生完成了这些病例。在肾绞痛病例中，91%的受访者建议将非甾体抗炎药（NSAID）作为一线治疗药物。仍有 18%的人建议使用丁溴东莨菪碱。在镇痛初始失败后，31%的人使用了强效阿片类药物。在胆绞痛病例中，分别有 59%和 31%的人建议将 NSAIDs 和丁溴东莨菪碱作为一线镇痛药。二线治疗时，22%的人会使用丁溴东莨菪碱。对于右下腹疼痛的病例，81%的人最初会使用对乙酰氨基酚进行治疗。如果一线治疗不足，13%的受访者不会给予进一步的镇痛治疗。
我们的结果表明，教师对急性疼痛管理循证指南的遵循情况不足。因此，应更加关注提高教师在疼痛管理方面的知识和技能。
