Mogensen S, Berglund L, Eriksson M
Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
Acta Anaesthesiol Scand. 2014 Feb;58(2):214-8. doi: 10.1111/aas.12232. Epub 2013 Dec 15.
Insertion of an epidural catheter for pain relief is frequently used in anaesthetic practice. Little is known regarding patients' expected vs. experienced pain and discomfort due to the epidural block procedure. The purpose of this study was to investigate the expected and experienced pain, respectively, associated with the epidural procedure in patients undergoing major abdominal surgery.
Thirty adult, unselected patients scheduled for elective major abdominal surgery were included in this study, which was approved by the ethics committee. Pre-operative insertion of an epidural catheter had to be a part of the anaesthetic routine procedure. Immediately before the epidural procedure, the patients were asked to grade the pain they expected from the procedure on an 11-point numeric rating system scale, ranging from 0 to 10, where '0' is no pain and '10' is worst imaginable pain. When the procedure had been carried out, the patients were once again asked to grade how much pain they had experienced.
The median expected pain as a result of the epidural procedure was 5.0. Median experienced pain was 2.0. The median difference between the expected and experienced pain was -3.0 (P < 0.0001). The only patient who expected less pain than she subsequently experienced had a paraesthetic sensation. Gender, age, or previous experience from central neuraxial block did not significantly affect neither expected nor experienced pain.
Patients expect significantly more pain than they experience from receiving an epidural block.
在麻醉实践中，常通过插入硬膜外导管来缓解疼痛。对于硬膜外阻滞操作导致的患者预期疼痛与实际经历的疼痛和不适，人们了解甚少。本研究的目的是分别调查接受腹部大手术患者在硬膜外操作过程中的预期疼痛和实际经历的疼痛。
本研究纳入了30例计划接受择期腹部大手术的成年患者，该研究经伦理委员会批准。术前插入硬膜外导管必须是麻醉常规操作的一部分。在硬膜外操作即将开始前，要求患者在0至10的11点数字评分系统量表上对他们预期该操作会带来的疼痛进行评分，其中“0”表示无疼痛，“10”表示难以想象的最严重疼痛。当操作完成后，再次要求患者对他们所经历的疼痛程度进行评分。
硬膜外操作导致的预期疼痛中位数为5.0。实际经历的疼痛中位数为2.0。预期疼痛与实际经历疼痛的中位数差值为 -3.0（P < 0.0001）。唯一预期疼痛比实际经历疼痛少的患者有一种感觉异常。性别、年龄或既往中枢神经轴索阻滞经历对预期疼痛和实际经历的疼痛均无显著影响。
患者预期的疼痛比接受硬膜外阻滞实际经历的疼痛要多得多。
