Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Injury. 2012 Nov;43(11):1958-61. doi: 10.1016/j.injury.2012.08.018. Epub 2012 Aug 16.
American patients are prescribed more opioid pain medication than Dutch patients after operative treatment of an ankle fracture, but it is possible that pain is undertreated in Dutch patients. This study tests if there is a difference in pain and satisfaction with pain relief between Dutch and American patients after operative treatment of ankle fractures.
Thirty American and 30 Dutch patients were enrolled in a prospective comparative study prior to operative treatment of ankle fractures. Patients rated pain and satisfaction with pain relief on postoperative day 1 (POD1) and at time of suture removal (SR). Pain and satisfaction scores were compared and multivariable analysis identified their predictors.
At POD1, a third of Dutch patients used no opioids and a sixth took strong opioids. At SR, only 4 of 30 (13%) were taking tramadol and half were taking no medication. All of the American patients used strong opioid pain medication on POD1 and 19 of 30 (63%) were still taking strong opioids at SR. Patients that did not use opioids and Dutch patients had less pain and equivalent satisfaction with pain relief compared to patients that used opioids and American patients respectively. Nationality was the best predictor of pain intensity at POD1. Opioid medication was the best predictor of pain at SR and decreased satisfaction with pain management.
Pain and satisfaction with pain relief are culturally mediated. Patients that use non-opioid pain medication report less pain and greater satisfaction with pain relief than patients managed with opioid pain medication.
Level I, Prognostic Study with more than 80% follow-up.
在美国，踝关节骨折手术后患者开具的阿片类止痛药比荷兰患者多，但荷兰患者的疼痛可能治疗不足。本研究旨在比较荷兰和美国踝关节骨折手术后患者的疼痛程度和疼痛缓解满意度是否存在差异。
在接受踝关节骨折手术治疗之前，前瞻性地纳入了 30 名美国患者和 30 名荷兰患者。患者在术后第 1 天（POD1）和拆线时（SR）对疼痛和疼痛缓解满意度进行评分。比较疼痛和满意度评分，并进行多变量分析以确定其预测因素。
在 POD1，三分之一的荷兰患者未使用阿片类药物，六分之一的患者使用强阿片类药物。在 SR，只有 30 名患者中的 4 名（13%）服用曲马多，一半患者未服用任何药物。所有美国患者在 POD1 使用强阿片类止痛药，在 SR，仍有 19 名患者（63%）使用强阿片类止痛药。未使用阿片类药物的患者和荷兰患者的疼痛程度较轻，且对疼痛缓解的满意度与未使用阿片类药物和美国患者相当。国籍是 POD1 时疼痛强度的最佳预测因素。阿片类药物是 SR 时疼痛和降低的疼痛管理满意度的最佳预测因素。
疼痛和疼痛缓解满意度受到文化的影响。与使用阿片类药物管理的患者相比，使用非阿片类药物管理的患者报告的疼痛程度较轻，对疼痛缓解的满意度更高。
Ⅰ级，具有超过 80%随访的预后研究。
