Department of anaesthesiology and intensive care medicine, hospices Civils de Lyon, Lyon Croix Rousse university hospital, HESPER 7425 research team, Claude-Bernard Lyon 1 University, 69004 Lyon, France.
Department of anaesthesia and intensive care, CHU de Rennes, Inserm UMR 991 and CIC 1414, Rennes 1 university, 35033 Rennes, France.
Anaesth Crit Care Pain Med. 2019 Jun;38(3):223-229. doi: 10.1016/j.accpm.2018.08.004. Epub 2018 Oct 16.
Since pain and post-operative nausea and vomiting (PONV) are the main reasons for failed discharge after day-case surgery, assessing pain and PONV is important. The aim was to describe the perioperative pain and PONV management within selected day-case surgical procedures in France.
The OPERA trial was carried out on given days between December 2013 and December 2014. Each participating centre was required to fill out 3 separate questionnaires aiming at describing (1) protocols about pain and PONV, (2) patients' characteristics and procedures, (3) analgesic and PONV practice patterns for selected procedures.
Over the two days of investigation in each of the 221 randomly selected healthcare institutions, 7382 patients were included, of whom 2144 patients above 12 years underwent one of 10 selected procedures. Among responding institutions, 40% [33;47] had a dedicated pain management written protocol. Combination of tramadol and paracetamol was the most commonly prescribed (78% [71;83] of centres). Oral morphine was prescribed in 59/199 (30% [23; 37]) centres, for home treatment in 25/59 (42% [30; 56]) centres. However, there was no standardised take-home analgesic and PONV strategies for selected surgical procedures at risk of moderate to severe pain. PONV management guidance after discharge was included in only 12 % of centres.
This survey demonstrates that practice patterns for pain treatment and PONV prophylaxis after ambulatory surgery vary among French centres and are not always in line with national guidelines. Strategies to improve practices and make them more homogeneous are necessary.
由于疼痛和术后恶心呕吐（PONV）是日间手术出院失败的主要原因，因此评估疼痛和 PONV 非常重要。本研究旨在描述法国部分日间手术中围手术期疼痛和 PONV 的管理情况。
OPERA 试验于 2013 年 12 月至 2014 年 12 月期间在特定日期进行。每个参与中心都需要填写 3 份单独的问卷，旨在描述（1）疼痛和 PONV 管理方案，（2）患者特征和手术，（3）选定手术的镇痛和 PONV 实践模式。
在每个随机选择的 221 个医疗机构的两天调查期间，共纳入 7382 名患者，其中 2144 名 12 岁以上患者接受了 10 项选定手术中的一项。在参与的医疗机构中，40%（33/82）有专门的疼痛管理书面方案。曲马多和对乙酰氨基酚联合使用是最常开的处方（78%[71/91]的中心）。59/199（30%[23/78]）个中心开了口服吗啡，25/59（42%[30/72]）个中心用于家庭治疗。然而，对于有中度至重度疼痛风险的选定手术，没有标准化的带出院镇痛和 PONV 策略。只有 12%的中心在出院后包含 PONV 管理指南。
本调查表明，法国各中心日间手术术后疼痛治疗和 PONV 预防的实践模式存在差异，并且并不总是符合国家指南。有必要制定策略来改进实践并使其更加同质化。
