Orthopedic and Arthritis Center for Outcomes Research (C.A.D, A.Y., R.G.K., R.G., T.S.T., and J.N.K.), Department of Orthopedic Surgery (T.S.T. and J.N.K.), and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women's Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts.
Orthopedic and Arthritis Center for Outcomes Research (C.A.D, A.Y., R.G.K., R.G., T.S.T., and J.N.K.), Department of Orthopedic Surgery (T.S.T. and J.N.K.), and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women's Hospital, Boston, Massachusetts.
J Bone Joint Surg Am. 2016 Jun 15;98(12):e50. doi: 10.2106/JBJS.15.01004.
U.S. practitioners have prescribed opioid analgesics increasingly in recent years, contributing to what has been declared an opioid epidemic by the U.S. Centers for Disease Control and Prevention (CDC). Opioids are used frequently in the preoperative and postoperative periods for patients undergoing total joint replacement in developed countries, but cross-cultural comparisons of this practice are limited. An international medical mission such as Operation Walk Boston, which provides total joint replacement to financially vulnerable patients in the Dominican Republic, offers a unique opportunity to compare postoperative pain management approaches in a developed nation and a developing nation.
We interviewed American and Dominican surgeons and nurses (n = 22) during Operation Walk Boston 2015. We used a moderator's guide with open-ended questions to inquire about postoperative pain management and factors influencing prescribing practices. Interviews were recorded and transcripts were analyzed using content analysis.
Providers highlighted differences in the patient-provider relationship, pain medication prescribing variability, and access to medications. Dominican surgeons emphasized adherence to standardized pain protocols and employed a paternalistic model of care, and American surgeons reported prescribing variability and described shared decision-making with patients. Dominican providers described limited availability of potent opioid preparations in the Dominican Republic, in contrast to American providers, who discussed opioid accessibility in the United States.
Our findings suggest that cross-cultural comparisons provide insight into how opioid prescribing practices, approaches to the patient-provider relationship, and medication access inform distinct pain management strategies in American and Dominican surgical settings. Integrating lessons from cross-cultural pain management studies may yield more effective pain management strategies for surgical procedures performed in the United States and abroad.
近年来，美国医生越来越多地开出阿片类镇痛药，这导致美国疾病控制与预防中心（CDC）宣布阿片类药物泛滥。在发达国家，接受全关节置换的患者在围手术期经常使用阿片类药物，但这种做法的跨文化比较有限。波士顿行动步行手术等国际医疗任务为多米尼加共和国经济困难的患者提供全关节置换手术，为在发达国家和发展中国家比较术后疼痛管理方法提供了独特的机会。
我们在 2015 年波士顿行动步行手术期间采访了美国和多米尼加的外科医生和护士（n=22）。我们使用带有开放式问题的主持人指南，询问术后疼痛管理和影响处方实践的因素。采访进行了录音，并使用内容分析法对记录和转录本进行了分析。
提供者强调了医患关系、止痛药处方差异和获得药物的差异。多米尼加外科医生强调遵守标准化疼痛方案和采用家长式的护理模式，而美国外科医生则报告了处方的差异，并描述了与患者共同决策。多米尼加医生描述了多米尼加共和国强力阿片制剂的供应有限，而美国医生则讨论了美国阿片类药物的可及性。
我们的研究结果表明，跨文化比较可以深入了解阿片类药物处方实践、医患关系方法和药物获取如何在美国家庭和多米尼加外科环境中告知不同的疼痛管理策略。整合跨文化疼痛管理研究的经验教训可能会为在美国和国外进行的手术提供更有效的疼痛管理策略。
