Callebaut Ina, Jorissen Steffe, Pelckmans Caroline, Berends Noor, Droogmans Martijn, van Rossum Maxime, Nulens Marijke, Stessel Bjorn
Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium.
Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium.
Anesth Pain Med. 2020 Jun 9;10(3):e101669. doi: 10.5812/aapm.101669. eCollection 2020 Jun.
Nowadays, complicated and painful surgical procedures are encouraged to be carried out in an ambulatory setting.
The current study aimed to assess 4-week postoperative pain profiles of 4 painful ambulatory surgical procedures. We analyzed the prevalence of and reasons for non-adherence and partial adherence of patients to a predefined treatment schedule after the ambulant surgery.
The current study analyzed data from a large randomized trial by evaluating the effect of postoperative pain medication on acute postoperative pain at home during the first 4 postoperative days (POD) in patients scheduled for ambulatory hemorrhoid surgery, shoulder or knee arthroscopy, and inguinal hernia repair. Postoperative pain intensity was assessed at POD 0, 1, 2, 3, 4, 7, 14, and 28 via the Numeric Rating Scale (NRS). Adherence was assessed on POD 1, 2, 3, and 4.
Median average pain scores were above an NRS of 3 during the first postoperative week after shoulder arthroscopy and even above 4 during the first postoperative week after hemorrhoid surgery. 26% of patients undergoing shoulder arthroscopy and hemorrhoid surgery still had moderate pain 1 week after surgery. Median average pain scores were below an NRS of 3 during the whole study period after inguinal hernia repair and knee arthroscopy. 24.61% of patients did not use the study medication as prescribed, 5.76% of whom were non-adherent, and 18.85% were partially adherent.
Each type of ambulant surgery has its unique postoperative pain profile. New strategies should be developed for pain therapy at home, particularly after the ambulatory arthroscopic shoulder surgery and hemorrhoid surgery. Non-adherence is uncommon if they are provided with a multimodal analgesic home kit together with clear verbal, written instructions, and intensive follow-up.
如今，鼓励在门诊环境中开展复杂且痛苦的外科手术。
本研究旨在评估4种痛苦的门诊手术术后4周的疼痛情况。我们分析了门诊手术后患者未依从和部分依从预定义治疗方案的发生率及原因。
本研究通过评估术后疼痛药物对计划进行门诊痔疮手术、肩部或膝关节关节镜检查以及腹股沟疝修补术的患者术后前4天在家中急性术后疼痛的影响，分析了一项大型随机试验的数据。术后疼痛强度在术后第0、1、2、3、4、7、14和28天通过数字评分量表（NRS）进行评估。在术后第1、2、3和4天评估依从性。
肩关节镜检查术后第一周，平均疼痛评分中位数高于NRS 3，痔疮手术后第一周甚至高于4。接受肩关节镜检查和痔疮手术的患者中有26%在术后1周仍有中度疼痛。腹股沟疝修补术和膝关节镜检查术后整个研究期间，平均疼痛评分中位数低于NRS 3。24.61%的患者未按规定使用研究药物，其中5.76%为完全不依从，18.85%为部分依从。
每种门诊手术都有其独特的术后疼痛情况。应制定新的家庭疼痛治疗策略，尤其是在门诊肩关节镜手术和痔疮手术后。如果为患者提供多模式镇痛家庭套装以及清晰的口头、书面说明和密集随访，不依从情况并不常见。
