Medical Faculty, University of Leipzig, Germany.
Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Germany.
Eur J Pain. 2017 Nov;21(10):1723-1731. doi: 10.1002/ejp.1084. Epub 2017 Jul 18.
The goal was to test the effectiveness of a structured pain management programme after invasive electrophysiological interventions in cardiology including ablation of atrial fibrillation (AF) or ventricular tachycardia (VT) and implantation, or explantation, of pacemakers or implantable cardioverter defibrillators.
This was a prospective study with a pre-/post-design where a post-intervention group (116 consecutive patients) was compared to a pre-intervention group (102 consecutive patients) after implementation of a structured pain-management programme using the numeric rating scale (NRS 0-10) and classified as moderate-to-severe if NRS > 3. Measurements were recorded every two hours during the first 24 h post-operatively. The location of the pain and the amount of analgesic used were also recorded.
The proportion of patients who experienced moderate-to-severe pain after the procedure decreased after initiation of the pain-management program: 47% versus 61%; p = 0.048. This difference was driven primarily by reduced pain late (8-24 h) after the procedure; 16% versus 39%; p < 0.001. The risk to develop late (8-24 h) post-procedural pain was reduced approximately three-fold after implementation of the pain-management programme (OR = 0.32, 95% CI 0.16-0.64, p = 0.001). Multivariate analysis indicated chronic pain, early pain (0-6 h), and type of intervention were associated with late post-interventional pain. In contrast, age, diabetes mellitus, BMI, gender and procedure time were not related.
The findings illustrate the potential value of a structured pain-management programme. The proportion of patients who experienced moderate-to-severe pain after these electrophysiological procedures decreased significantly.
This is the first exploratory study that evaluates the impact of a multidisciplinary pain-management programme after cardiac electrophysiological interventions. It demonstrates that significant quality improvement is achievable following simple rules together with patient and staff education. The programme reduces the proportion of patients with moderate-to-severe pain after electrophysiological procedures significantly.
本研究旨在测试心脏介入术后采用结构化疼痛管理方案对改善疼痛的效果，包括房颤（AF）或室性心动过速（VT）消融、心脏起搏器或植入式心律转复除颤器（ICD）的植入或取出。
这是一项前瞻性研究，采用前后对照设计。在实施结构化疼痛管理方案后，对比介入治疗前（102 例连续患者）和介入治疗后（116 例连续患者）。采用数字评分法（NRS 0-10）评估疼痛程度，NRS＞3 定义为中重度疼痛。术后 24 小时内每 2 小时记录一次疼痛程度，同时记录疼痛部位和镇痛药物使用剂量。
疼痛管理方案实施后，中重度疼痛的患者比例从 61%下降至 47%（p=0.048）。该差异主要由术后晚期（8-24 小时）疼痛减轻所致，晚期疼痛发生率从 39%下降至 16%（p＜0.001）。实施疼痛管理方案后，患者发生术后晚期疼痛的风险降低约三分之二（OR=0.32，95%CI 0.16-0.64，p=0.001）。多变量分析表明，慢性疼痛、早期疼痛（0-6 小时）和干预类型与术后晚期疼痛相关，而年龄、糖尿病、BMI、性别和手术时间与术后晚期疼痛无关。
该研究结果表明结构化疼痛管理方案具有潜在价值，接受心脏电生理介入治疗的患者中重度疼痛的比例显著降低。
这是第一项评估心脏电生理介入治疗后多学科疼痛管理方案对疼痛影响的探索性研究，结果表明，通过患者和医护人员教育，遵循简单的方案可以显著提高疼痛管理质量。该方案可显著降低心脏电生理介入治疗后中重度疼痛的发生比例。
