三级护理医院中用于术后疼痛管理的连续导管镇痛的并发症。技术并发症的发生率及所采用的替代镇痛方法。
Complications of continuous catheter analgesia for postoperative pain management in a tertiary care hospital. Incidence of technical complications and alternative analgesia methods used.
作者信息
Recasens A, Hidalgo A, Faulí A, Dürsteler C, Arguis M J, Gomar C
机构信息
Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España.
Servicio de Anestesiología y Reanimación, Hospital Clínic i Provincial de Barcelona, Barcelona, España.
出版信息
Rev Esp Anestesiol Reanim (Engl Ed). 2019 Feb;66(2):84-92. doi: 10.1016/j.redar.2018.08.008. Epub 2018 Nov 23.
BACKGROUND
Continuous invasive analgesia remains the gold-standard method for managing acute post-operative pain after major surgery. However, this procedure is not exempt from complications that may have detrimental effects on the patient and affect the post-operative recovery process. Data of the complications of continuous catheter analgesic techniques (CCATs) and their impact on pain relief are scarce in the literature.
MATERIAL AND METHODS
We conducted a prospective longitudinal study and patients who underwent a surgical procedure and received continuous invasive analgesia after surgery were included. Post-operative analgesic strategy, pain scores (NRS), CCAT's characteristics and technical complications were recorded. Patient satisfaction was determined. Descriptive statistics and Student's t-tests were applied for the comparative analyses.
RESULTS
We collected data from 106 patients. Mean duration of the CCAT was 47.52±21.23hours and 52 patients (49.1%) were controlled in conventional hospitalisation units whereas 54 patients (50.9%) were controlled on intensive or high-dependency care units. The overall incidence of technical complications was 9.43%. The most common complications were catheter displacement (2.38%), inflammation at the IV catheter insertion point (2.38%) and excessive dosing of analgesic drugs (2.38%). Mean NRS scores were ≤3 during the permanence of CCATs. Maximum pain intensity was significantly higher in patients who suffered technical complications (mean±standard deviation [x̅ ± SD]: 4.4 ± 2.8 vs. 2.9 ± 1.9; P<0.05). Satisfaction levels with the technique and overall satisfaction with the pain management strategy were negatively impacted by the occurrence of complications.
CONCLUSIONS
The incidence of technical complications of CCATs was 9.43% and had a negative impact in pain control and patient's satisfaction.
背景
持续有创镇痛仍然是大型手术后急性术后疼痛管理的金标准方法。然而，该方法也难免会出现一些并发症，这些并发症可能对患者产生不利影响，并影响术后恢复过程。关于连续导管镇痛技术（CCATs）并发症及其对疼痛缓解影响的数据在文献中较为匮乏。
材料与方法
我们进行了一项前瞻性纵向研究，纳入了接受外科手术并在术后接受持续有创镇痛的患者。记录术后镇痛策略、疼痛评分（NRS）、CCATs的特点和技术并发症。确定患者满意度。应用描述性统计和学生t检验进行比较分析。
结果
我们收集了106例患者的数据。CCATs的平均持续时间为47.52±21.23小时，52例患者（49.1%）在传统住院病房接受管理，而54例患者（50.9%）在重症或高依赖护理病房接受管理。技术并发症的总体发生率为9.43%。最常见的并发症是导管移位（2.38%）、静脉导管插入点炎症（2.38%）和镇痛药过量给药（2.38%）。在CCATs持续期间，平均NRS评分≤3。发生技术并发症的患者的最大疼痛强度显著更高（平均值±标准差[x̅ ± SD]：4.4 ± 2.8 vs. 2.9 ± 1.9；P<0.05）。并发症的发生对该技术的满意度和对疼痛管理策略的总体满意度产生了负面影响。
结论
CCATs技术并发症的发生率为9.43%，对疼痛控制和患者满意度产生了负面影响。
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