Khatib Samina Khaliloddin, Razvi Syed Shamim, Kulkarni Sadhana Sudhir, Parab Swapnil
Department of Anaesthesiology, Government Medical College, Aurangabad, India.
Department of Orthopaedics, Mahatma Gandhi Institute of Health Sciences, Mumbai, Maharashtra, India.
Indian J Anaesth. 2017 Mar;61(3):215-224. doi: 10.4103/ija.IJA_506_16.
Undertreated pain can have negative consequences on patients' health as well as the health-care system. The present study was aimed at identifying the current trends in post-operative pain management and availability of acute pain services (APS). In addition, it is also an attempt to assess the availability of analgesia for non-surgical cases, and the attitudes, beliefs, and perceptions of clinicians regarding acute pain management in the tertiary hospitals in the state of Maharashtra (India).
This was a cross-sectional, multicentre questionnaire survey involving the anaesthesiologists and surgeons. Percentages, median, interquartile ranges were calculated and compared by employing a Wilcoxon sign rank test.
Data from thirty centres revealed that the surgeons played a major role in treating pain, while most of the anaesthesiologists treated pain primarily in the operation theatre and recovery room. An APS was operational in seven hospitals. The most frequently employed techniques to achieve analgesia were the administration of non-steroidal anti-inflammatory drugs, opioids and epidural analgesia. The majority of the centres had no written protocol and dedicated staff for pain management, pain assessment was not adequately stressed, and only five out of the thirty centres included in the study provided ongoing pain education to health professionals even when the hospitals claimed to provide APS. The major hurdles in providing optimal analgesia and implementing APS were a lack of pain education, equipment and administrative problems.
Thus, the tertiary centres in Maharashtra fall short of providing optimal acute post-operative pain management.
疼痛治疗不充分会对患者健康以及医疗保健系统产生负面影响。本研究旨在确定术后疼痛管理的当前趋势以及急性疼痛服务(APS)的可及性。此外,本研究还试图评估非手术病例的镇痛可及性,以及印度马哈拉施特拉邦三级医院临床医生对急性疼痛管理的态度、信念和认知。
这是一项涉及麻醉医生和外科医生的横断面多中心问卷调查。计算百分比、中位数、四分位间距,并采用Wilcoxon符号秩和检验进行比较。
来自30个中心的数据显示,外科医生在疼痛治疗中发挥主要作用,而大多数麻醉医生主要在手术室和恢复室处理疼痛。7家医院设有急性疼痛服务。实现镇痛最常用的技术是非甾体抗炎药、阿片类药物和硬膜外镇痛。大多数中心没有疼痛管理的书面方案和专门人员,疼痛评估未得到充分重视,纳入研究的30个中心中只有5个中心为卫生专业人员提供持续的疼痛教育,即使这些医院声称提供急性疼痛服务。提供最佳镇痛和实施急性疼痛服务的主要障碍是缺乏疼痛教育、设备和管理问题。
因此,马哈拉施特拉邦的三级中心在提供最佳术后急性疼痛管理方面存在不足。