Biocic Marina, Vidosevic Dijana, Boric Matija, Boric Teo, Giunio Lovel, Fabijanic Damir, Puljak Livia
Laboratory for Pain Research, University of Split School of Medicine.
Department of Cardiology.
J Pain Res. 2017 Apr 19;10:927-932. doi: 10.2147/JPR.S132241. eCollection 2017.
The degree of pain caused by the implantation of cardiac electronic devices (CEDs) and the type of anesthesia or perioperative pain management used with the procedure have been insufficiently studied. The aim of this study was to analyze perioperative pain management, as well as intensity and location of pain among patients undergoing implantation of CED, and to compare the practice with published guidelines.
This was a combined retrospective and prospective study conducted at the tertiary hospital, University Hospital Split, Croatia. The sample included 372 patients who underwent CED implantation. Perioperative pain management was analyzed retrospectively in 321 patients who underwent CED implantation during 2014. In a prospective study, intensity and location of pain before, during, and after the procedure were measured by using a numerical rating scale (NRS) ranging from 0 to 10 in 51 patients at the same institution from November 2014 to August 2015.
A quarter of patients received analgesia or sedation before surgery. All the patients received local lidocaine anesthesia. After surgery, 31% of patients received pain medication or sedation. The highest pain intensity was observed during CED implantation with the highest NRS pain score being 8. Some patients reported severe pain (NRS >5) also at 1, 3, 6, 8, and 24 hours after surgery. The most common pain locations were surgical site, shoulder, and chest. Adherence to guidelines for acute perioperative pain management was insufficient.
Patients may experience severe pain during and after CED implantation. Perioperative pain management was suboptimal, and higher doses of sedation and intensive analgesia are required. Guidelines for acute perioperative pain management and anesthesia during CED implantation should be developed.
心脏电子装置（CED）植入所引起的疼痛程度以及该手术所使用的麻醉类型或围手术期疼痛管理方法尚未得到充分研究。本研究的目的是分析接受CED植入患者的围手术期疼痛管理情况，以及疼痛的强度和部位，并将实际做法与已发表的指南进行比较。
这是一项在克罗地亚斯普利特大学医院（一家三级医院）进行的回顾性与前瞻性相结合的研究。样本包括372例接受CED植入的患者。对2014年接受CED植入的321例患者的围手术期疼痛管理进行回顾性分析。在一项前瞻性研究中，于2014年11月至2015年8月期间在同一机构对51例患者使用0至10的数字评分量表（NRS）测量手术前、手术期间和手术后疼痛的强度和部位。
四分之一的患者在手术前接受了镇痛或镇静。所有患者均接受局部利多卡因麻醉。术后，31%的患者接受了止痛药物或镇静治疗。在CED植入过程中观察到最高疼痛强度，NRS疼痛评分最高为8分。一些患者在术后1、3、6、8和24小时也报告有重度疼痛（NRS>5）。最常见的疼痛部位是手术部位、肩部和胸部。对急性围手术期疼痛管理指南的遵循情况不足。
患者在CED植入期间和之后可能会经历重度疼痛。围手术期疼痛管理欠佳，需要更高剂量的镇静和强化镇痛。应制定CED植入期间急性围手术期疼痛管理和麻醉的指南。
