Department of Anesthesiology and Intensive Care, Hospital Clinic, Barcelona, Spain.
Department of Anesthesiology, Institut Hospital del Mar d'Investigacions Mèdiques-Hospital del Mar-Universitat Autònoma de Barcelona, Barcelona, Spain.
J Pain. 2017 Oct;18(10):1237-1252. doi: 10.1016/j.jpain.2017.05.006. Epub 2017 Jun 12.
Pain after surgery remains a problem worldwide, although there are no published data on postoperative outcomes in Spain. We evaluated 2,922 patients on the first day after surgery in 13 tertiary care Spanish hospitals, using the PAIN-OUT questionnaire. The aims were to: assess postoperative outcomes and anesthetic/analgesic management in Orthopedics (ORT) and General Surgery (GEN) patients; explore the influence of the analgesic therapy on outcomes and opioid requirements; evaluate and compare outcomes and analgesic management according to surgical procedure. Mean worst pain and percentage of patients in severe pain were 5.6 (on a numeric rating scale of 0-10) and 39.4%, respectively, slightly lower than those reported in Western countries (range, 5.0-8.4 and 33-55%). Patients' pain assessment (83.1%) and information were high (63.3%), but participation in decision-making (4.8) was lower than in the United States (7.0) and Europe (Germany, France, Norway, and Denmark; mean, 5.9). Patients after orthopedic surgery had the worst outcomes. General anesthesia was more frequent in GEN patients, whereas regional (central and peripheral) was more frequent in ORT surgery patients. Mean opioid consumption (20.2 mg per patient per 24 hours, oral morphine equivalents), was lower than reported and decreased >50% after regional analgesia. Intravenous morphine patient-controlled analgesia was seldom used (6.2%). Acute opioid treatments were associated with worsened outcomes whereas multimodal analgesia (mainly antipyretic analgesics-nonsteroidal anti-inflammatory drugs-opioids) were associated with improved results. Epidurals in abdominal surgery (16.7%) were also associated with better outcomes. Presurgical chronic pain (>7) and/or chronic opioid consumption, were associated with worsened pain outcomes; the latter with a 50% increase in postoperative opioid requirements. Tibia/fibula and foot surgeries (ORT), and gastric, small intestine, and anterior abdominal wall procedures (GEN) were the most painful. Rigorous control of chronic pain before surgery, and combining opioids with adjuvants and other analgesics perioperatively, might improve postoperative outcomes.
We analyzed postoperative outcomes and analgesic management in patients from tertiary care Spanish hospitals. The study serves as a point of comparison with other Western countries and shows that pain intensity outcomes and opioid consumption were slightly better in the Spanish population. Chronic pain before surgery (numeric rating scale score >7) and/or chronic opioid consumption, were associated with worsened pain outcomes, suggesting that rigorous control of chronic pain before surgery, and combining opioids with adjuvants and other analgesics perioperatively, might improve outcomes. Patients' pain participation in decision-making was inadequate and should be improved in Spanish hospitals.
尽管西班牙尚未发表术后结果的相关数据，但全球范围内术后疼痛仍然是一个问题。我们在西班牙 13 家三级护理医院对 2922 名术后第一天的患者使用 PAIN-OUT 问卷进行了评估。目的是评估骨科（ORT）和普外科（GEN）患者的术后结果和麻醉/镇痛管理；探讨镇痛治疗对结果和阿片类药物需求的影响；根据手术过程评估和比较结果和镇痛管理。术后第一天的平均最差疼痛和严重疼痛患者比例分别为 5.6（0-10 数字评分量表）和 39.4%，略低于西方国家（范围为 5.0-8.4 和 33-55%）。患者的疼痛评估（83.1%）和信息获取（63.3%）较高，但参与决策（4.8）低于美国（7.0）和欧洲（德国、法国、挪威和丹麦；平均 5.9）。骨科手术后患者的结果最差。GEN 患者更常使用全身麻醉，而 ORT 手术患者更常使用区域麻醉（中枢和外周）。（口服吗啡等效物）的阿片类药物消耗均值（每位患者 24 小时 20.2mg）低于报告值，并在区域镇痛后减少>50%。静脉内吗啡患者自控镇痛很少使用（6.2%）。急性阿片类药物治疗与结果恶化相关，而多模式镇痛（主要为解热镇痛非甾体抗炎药-阿片类药物）与改善结果相关。腹部手术中的硬膜外（16.7%）也与更好的结果相关。术前慢性疼痛（>7）和/或慢性阿片类药物使用与疼痛结果恶化相关，后者使术后阿片类药物需求增加 50%。胫骨/腓骨和足部手术（ORT）以及胃、小肠和前腹壁手术（GEN）是最疼痛的。在术前严格控制慢性疼痛，并在围手术期将阿片类药物与辅助药物和其他镇痛药结合使用，可能会改善术后结果。
我们分析了来自西班牙三级护理医院的患者的术后结果和镇痛管理。该研究与其他西方国家进行了比较，并表明西班牙人群的疼痛强度结果和阿片类药物消耗略好。术前慢性疼痛（数字评分量表评分>7）和/或慢性阿片类药物使用与疼痛结果恶化相关，这表明术前严格控制慢性疼痛，并在围手术期将阿片类药物与辅助药物和其他镇痛药结合使用，可能会改善结果。患者在决策中的疼痛参与度不足，西班牙医院应加以改善。
