Park Sookyung, Chi Seong In, Seo Kwang-Suk, Kim Hyun Jeong
Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea.
Department of Dental Anesthesiology, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea.
J Dent Anesth Pain Med. 2015 Sep;15(3):141-146. doi: 10.17245/jdapm.2015.15.3.141. Epub 2015 Sep 30.
An understanding of the features of postoperative pain is essential for optimal analgesic dosing strategies. Using a visual analogue scale (VAS) score and patient controlled analgesia (PCA) infusion pattern analysis, an anesthesiologist can estimate when and how severely patients suffer from pain. Several reports have been published about circadian changes in the pain threshold. Postoperative pain was analyzed retrospectively in 250 patients who underwent orthognathic surgery.
A total of 250 patients were allocated into two groups according to the time of recovery from anesthesia. Patients in the early group (group E) recovered from anesthesia before 06:00 p.m. Patients in the late group (group L) recovered from anesthesia after 06:00 p.m. All patients received intravenous patient controlled analgesia (IV PCA) at the end of the operation. The VAS score of pain intensity was measured. Self-administration of bolus analgesic from the IV PCA device was also analyzed according to actual time and elapsed time.
VAS scores showed no difference between the two groups except 36 hours after recovery from anesthesia. On POD1, there were two peaks for self-administration of bolus analgesics in group L and one peak in the morning for group E. Two peaks each in the morning and in the afternoon were shown in both groups on POD2.
Diurnal variance in pain should be considered for effective dosing strategies.
了解术后疼痛的特征对于制定最佳镇痛给药策略至关重要。通过视觉模拟评分法（VAS）评分和患者自控镇痛（PCA）输注模式分析，麻醉医生可以估计患者何时以及疼痛程度如何。已有多篇关于疼痛阈值昼夜变化的报道。对250例行正颌手术的患者的术后疼痛进行回顾性分析。
根据麻醉恢复时间将250例患者分为两组。早期组（E组）患者在下午6点前从麻醉中恢复。晚期组（L组）患者在下午6点后从麻醉中恢复。所有患者在手术结束时接受静脉自控镇痛（IV PCA）。测量疼痛强度的VAS评分。还根据实际时间和经过时间分析了IV PCA装置中患者自行推注镇痛药的情况。
除麻醉恢复36小时后，两组的VAS评分无差异。在术后第1天，L组患者自行推注镇痛药有两个高峰，E组患者在上午有一个高峰。在术后第2天，两组患者在上午和下午均各有两个高峰。
有效的给药策略应考虑疼痛的昼夜变化。
