Chin A, Heywood L, Iu P, Pelecanos A M, Barrington M J
Specialist Anaesthetist, Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Narcosia Anaesthesia Group, Brisbane, Queensland.
Specialist Anaesthetist, Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Narcosia Anaesthesia Group, Brisbane, Queensland.
Anaesth Intensive Care. 2017 Nov;45(6):714-719. doi: 10.1177/0310057X1704500611.
Dedicated regional anaesthesia services incorporating block rooms and/or block teams may facilitate theatre efficiency and improve training in regional anaesthesia. Currently, it is unknown if a dedicated regional anaesthesia service improves the effectiveness of regional anaesthesia. In November 2013, the Royal Brisbane and Women's Hospital established a dedicated regional anaesthesia service comprising a block team and a block room. Pre-intervention (conventional model of care) registry data was retrospectively compared with post-intervention (dedicated regional anaesthesia service) audit data, with regard to pain and opioid requirement in the post-anaesthesia care unit (PACU). The primary outcome was inadequate analgesia, defined as a numerical rating scale (NRS; 0, no pain; 10, worst pain imaginable) for pain >5 in the PACU. Pre- and post-intervention, 43.7% and 27.7% of patients respectively reported a NRS >5 ( <0.001). A difference in the type of blocks and surgery performed may have accounted for the improved outcome seen post-intervention. After adjustment for American Society of Anesthesiologists physical status, block type and surgery type, the odds ratio of having inadequate analgesia (NRS >5) was 0.54 (95% confidence interval 0.39 to 0.76) for post-intervention compared to pre-intervention. Secondary outcomes examined pre- and post-intervention were the absence of pain (39.3% and 55.1% of patients, respectively, <0.001), systemic opioid analgesia requirement (48.6% and 30.5% of patients respectively, <0.001) and median maximum NRS (4 [interquartile range (IQR) 0 to 8] and 0 [IQR 0 to 6] respectively, <0.001). A dedicated regional anaesthesia service was associated with improved effectiveness of regional anaesthesia.
配备阻滞室和/或阻滞团队的专门区域麻醉服务可能会提高手术室效率，并改善区域麻醉培训。目前，尚不清楚专门的区域麻醉服务是否能提高区域麻醉的效果。2013年11月，皇家布里斯班妇女医院设立了一个专门的区域麻醉服务部门，包括一个阻滞团队和一个阻滞室。将干预前（传统护理模式）的登记数据与干预后（专门区域麻醉服务）的审计数据进行回顾性比较，比较内容为麻醉后护理单元（PACU）中的疼痛情况和阿片类药物需求。主要结局是镇痛不足，定义为PACU中疼痛数字评分量表（NRS；0表示无疼痛；10表示可想象到的最严重疼痛）评分>5。干预前和干预后，分别有43.7%和27.7%的患者报告NRS>5（<0.001）。所实施的阻滞类型和手术类型的差异可能是干预后观察到结局改善的原因。在对美国麻醉医师协会身体状况、阻滞类型和手术类型进行调整后，与干预前相比，干预后镇痛不足（NRS>5）的比值比为0.54（95%置信区间0.39至0.76）。干预前和干预后检查的次要结局包括无疼痛（分别为39.3%和55.1%的患者，<0.001）、全身性阿片类镇痛药物需求（分别为48.6%和30.5%的患者，<0.001）以及最大NRS中位数（分别为4[四分位间距（IQR）0至8]和0[IQR 0至6]，<0.001）。专门的区域麻醉服务与区域麻醉效果改善相关。
