Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Chin Med J (Engl). 2019 Dec 5;132(23):2812-2819. doi: 10.1097/CM9.0000000000000540.
Post-operative pain is unpleasant for patients and may worsen surgical recovery. Peri-operative multimodal analgesia has been used for many years; however, its efficacy still needs improvement. In the present study, a thorough peri-operative pain counseling and stratified management program based on risk assessment was implemented, with the goal of improving post-operative analgesia and patient satisfaction.
This prospective, controlled, pilot study included 361 patients who underwent elective surgery. Of these 361 patients, 187 received peri-operative pain risk assessment and stratified analgesia and counseling (stratified analgesia group), while 174 received conventional multimodal analgesia (conventional group). The two groups were compared regarding the post-operative pain intensity, rescue analgesia administration, post-operative quality of recovery as assessed via the quality of recovery 40 questionnaire, total dosage of peri-operative opioids, analgesic satisfaction, and analgesic costs.
Compared with the conventional group, the stratified analgesia group reported decreased pain intensity during motion at 24 h post-operatively and required lower dosages of rescue analgesia (P = 0.03). The total quality of recovery 40 questionnaire score and the scores for physical wellbeing and pain were significantly better in the stratified analgesia group than the conventional group (P = 0.04); the stratified analgesia group also reported better scores for analgesic satisfaction (P = 0.03) and received lower dosages of opioids (P = 0.03). Analgesic costs were lower in the stratified analgesia group than the conventional group; the cost-effective ratio was 109 in the conventional group and 62 in the stratified analgesia group.
The analgesic efficacy was improved by the implementation of stratified analgesia based on surgical pain risk assessment and counseling. This stratified analgesia protocol increased the patients' analgesic satisfaction and improved the quality of recovery without increasing healthcare costs. The present findings may help improve the efficacy of peri-operative multimodal analgesia in clinical practice.
NCT02728973; https://clinicaltrials.gov/ct2/show/NCT02728973?term=NCT02728973&draw=2&rank=1.
术后疼痛令患者不适，并可能影响手术康复。围手术期多模式镇痛已应用多年，但疗效仍有待提高。本研究旨在通过实施基于风险评估的围手术期疼痛全面咨询和分级管理方案，改善术后镇痛效果和患者满意度。
前瞻性、对照、初步研究纳入 361 例择期手术患者。其中 187 例患者接受围手术期疼痛风险评估和分级镇痛及咨询（分级镇痛组），174 例患者接受常规多模式镇痛（常规组）。比较两组患者术后疼痛强度、解救镇痛药物使用、术后恢复质量（采用恢复质量 40 问卷评估）、围手术期阿片类药物总剂量、镇痛满意度和镇痛费用。
与常规组相比，分级镇痛组患者术后 24 h 运动时疼痛强度降低，需要的解救镇痛药物剂量较低（P=0.03）。分级镇痛组的恢复质量 40 问卷总分及身体舒适度和疼痛评分均明显优于常规组（P=0.04）；分级镇痛组的镇痛满意度评分也较高（P=0.03），阿片类药物用量较少（P=0.03）。分级镇痛组的镇痛费用低于常规组，常规组的成本效益比为 109，分级镇痛组为 62。
基于手术疼痛风险评估和咨询的分级镇痛可提高镇痛效果。该分级镇痛方案增加了患者的镇痛满意度，改善了恢复质量，且不增加医疗保健费用。本研究结果可能有助于提高围手术期多模式镇痛在临床实践中的疗效。
NCT02728973；https://clinicaltrials.gov/ct2/show/NCT02728973?term=NCT02728973&draw=2&rank=1.
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