Pratici E, Nebout S, Merbai N, Filippova J, Hajage D, Keita H
Service d'Anesthésie, CHU Louis Mourier, AP-HP, Université Paris 7, Paris, France.
Unité de Recherche Clinique - GH HUPNVS - Site Louis Mourier, AP-HP, Université Paris, Paris, France.
Int J Obstet Anesth. 2017 May;30:39-43. doi: 10.1016/j.ijoa.2017.02.001. Epub 2017 Feb 10.
This study aimed to determine the level of agreement between calculated percentage pain reduction, derived from visual analog or numerical rating scales, and patient-reported percentage pain reduction in patients having labor epidural analgesia.
In a prospective observational study, parturients were asked to rate their pain intensity on a visual analog scale and numerical rating scale, before and 30min after initiation of epidural analgesia. The percentage pain reduction 30min after epidural analgesia was calculated by the formula: 100×(score before epidural analgesia-score 30min after epidural analgesia)/score before epidural analgesia. To evaluate agreement between calculated percentage pain reduction and patient-reported percentage pain reduction, we computed the concordance correlation coefficient and performed Bland-Altman analysis.
Ninety-seven women in labor were enrolled in the study, most of whom were nulliparous, with a singleton fetus and in spontaneous labor. The concordance correlation coefficient with patient-reported percentage pain reduction was 0.76 (95% CI 0.6 to 0.8) and 0.77 (95% CI 0.6 to 0.8) for the visual analog and numerical rating scale, respectively. The Bland-Altman mean difference between calculated percentage pain reduction and patient-reported percentage pain reduction for the visual analog and numerical rating scales was -2.0% (limits of agreement at 29.8%) and 0 (limits of agreement at 28.2%), respectively.
The agreement between calculated percentage pain reduction from a visual analog or numerical rating scale and patient-reported percentage pain reduction in the context of labor epidural analgesia was moderate. The difference could range up to 30%. Patient-reported percentage pain reduction has advantages as a measurement tool for assessing pain management for childbirth but differences compared with other assessment methods should be taken into account.
本研究旨在确定采用视觉模拟评分法或数字评分法计算得出的疼痛减轻百分比与分娩硬膜外镇痛患者报告的疼痛减轻百分比之间的一致性水平。
在一项前瞻性观察研究中，要求产妇在硬膜外镇痛开始前及开始后30分钟，使用视觉模拟评分法和数字评分法对其疼痛强度进行评分。硬膜外镇痛30分钟后的疼痛减轻百分比通过以下公式计算：100×（硬膜外镇痛前评分 - 硬膜外镇痛30分钟后评分）/硬膜外镇痛前评分。为评估计算得出的疼痛减轻百分比与患者报告的疼痛减轻百分比之间的一致性，我们计算了一致性相关系数并进行了布兰德 - 奥特曼分析。
97名分娩女性纳入本研究，其中大多数为初产妇，单胎妊娠且为自然分娩。视觉模拟评分法和数字评分法与患者报告的疼痛减轻百分比的一致性相关系数分别为0.76（95%CI 0.6至0.8）和0.77（95%CI 0.6至0.8）。视觉模拟评分法和数字评分法计算得出的疼痛减轻百分比与患者报告的疼痛减轻百分比之间的布兰德 - 奥特曼平均差异分别为 -2.0%（一致性界限为29.8%）和0（一致性界限为28.2%）。
在分娩硬膜外镇痛的情况下，采用视觉模拟评分法或数字评分法计算得出的疼痛减轻百分比与患者报告的疼痛减轻百分比之间的一致性为中等。差异可能高达30%。患者报告的疼痛减轻百分比作为评估分娩疼痛管理的测量工具具有优势，但应考虑与其他评估方法的差异。
