van Boekel Regina L M, Vissers Kris C P, van de Vossenberg Glenn, de Baat-Ananta Mira, van der Sande Rob, Scheffer Gert Jan, Steegers Monique A H
*Department of Anesthesiology Pain and Palliative Medicine, Radboud University Medical Center †Faculty of Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
Clin J Pain. 2016 Aug;32(8):681-8. doi: 10.1097/AJP.0000000000000315.
A large number of patients still experience pain after surgery. This study investigates if epidural or regional analgesia (continuous infusion peripheral nerve blocks [CPNB]) provide superior pain relief compared with patient-controlled analgesia (PCIA) and identifies the incidence of minor and major adverse effects or complications of these techniques.
Prospectively collected data of postoperative patients from an online data registration system of a special dedicated nurse-based acute pain service were analyzed. The acute pain service consultations were documented from January 2008 to August 2013 in a university hospital in The Netherlands.
An analysis was applied on data of 12,399 consecutive patients. Results showed that patients who received epidural analgesia and CPNB reported lower pain scores than those who received PCIA, after undergoing the same procedures. In addition, pain scores at rest were significantly lower than movement-evoked pain scores, in abdominal surgery. Severe nausea was mostly observed in patients with PCIA and itching was most common in patients with epidural analgesia. Opioid-induced respiratory depression was found in 5 patients with PCIA.
Epidural analgesia and CPNB provide better pain relief to patients than PCIA, especially in dynamic pain scores of patients. Evaluating real patient data on every patient visit is important for further improvement of the quality of postoperative pain management. Pain scores may vary widely between patients with similar surgical procedures. Therefore, we recommend that future research focuses on personalized pain measurement and pain management, to improve clinical practice more intensely.
大量患者术后仍会经历疼痛。本研究调查硬膜外或区域镇痛（连续输注外周神经阻滞[CPNB]）与患者自控镇痛（PCIA）相比是否能提供更好的疼痛缓解，并确定这些技术的轻微和严重不良反应或并发症的发生率。
分析从一个基于护士的急性疼痛专项服务的在线数据登记系统中前瞻性收集的术后患者数据。2008年1月至2013年8月在荷兰一家大学医院记录了急性疼痛服务咨询情况。
对12399例连续患者的数据进行了分析。结果显示，在接受相同手术程序后，接受硬膜外镇痛和CPNB的患者报告的疼痛评分低于接受PCIA的患者。此外，在腹部手术中，静息时的疼痛评分显著低于运动诱发的疼痛评分。严重恶心主要见于PCIA患者，瘙痒在硬膜外镇痛患者中最常见。在5例PCIA患者中发现了阿片类药物引起的呼吸抑制。
硬膜外镇痛和CPNB比PCIA能为患者提供更好的疼痛缓解，尤其是在患者的动态疼痛评分方面。在每次患者就诊时评估真实的患者数据对于进一步提高术后疼痛管理质量很重要。相似手术程序的患者之间疼痛评分可能差异很大。因此，我们建议未来的研究集中在个性化疼痛测量和疼痛管理上，以更有力地改善临床实践。
