Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, 260, Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Ewha Womans University Medical Center Mokdong Hospital, Seoul, South Korea.
BMC Anesthesiol. 2021 Jan 25;21(1):29. doi: 10.1186/s12871-021-01245-5.
Pain assessment and management are important in postoperative circumstances as overdosing of opioids can induce respiratory depression and critical consequences. We aimed this study to check the reliability of commonly used pain scales in a postoperative setting among Korean adults. We also intended to determine cut-off points of pain scores between mild and moderate pain and between moderate and severe pain by which can help to decide to use pain medication.
A total of 180 adult patients undergoing elective non-cardiac surgery were included. Postoperative pain intensity was rated with a visual analog scale (VAS), numeric rating scale (NRS), faces pain scale revised (FPS-R), and verbal rating scale (VRS). The VRS rated pain according to four grades: none, mild, moderate, and severe. Pain assessments were performed twice: when the patients were alert enough to communicate after arrival at the postoperative care unit (PACU) and 30 min after arrival at the PACU. The levels of agreement among the scores were evaluated using intraclass correlation coefficients (ICCs). The cut-off points were determined by receiver operating characteristic curves.
The ICCs among the VAS, NRS, and FPS-R were consistently high (0.839-0.945). The pain categories were as follow: mild ≦ 5.3 / moderate 5.4 ~ 7.1 /severe ≧ 7.2 in VAS, mild ≦ 5 / moderate 6 ~ 7 / severe ≧ 8 in NRS, mild ≦ 4 / moderate 6 / severe 8 and 10 in FPS-R. The cut-off points for analgesics request were VAS ≧ 5.5, NRS ≧ 6, FPS-R ≧ 6, and VRS ≧ 2 (moderate or severe pain).
During the immediate postoperative period, VAS, NRS, and FPS-R were well correlated. The boundary between mild and moderate pain was around five on 10-point scales, and it corresponded to the cut-off point of analgesic request. Healthcare providers should consider VRS and other patient-specific signs to avoid undertreatment of pain or overdosing of pain medication.
疼痛评估和管理在术后情况下很重要，因为阿片类药物过量会导致呼吸抑制和严重后果。我们旨在研究常用疼痛量表在韩国成年人术后环境中的可靠性。我们还旨在确定疼痛评分介于轻度和中度疼痛之间以及中度和重度疼痛之间的切点，以便帮助决定使用疼痛药物。
共纳入 180 名接受择期非心脏手术的成年患者。术后疼痛强度采用视觉模拟评分法（VAS）、数字评分法（NRS）、修订面部疼痛量表（FPS-R）和言语评分法（VRS）进行评估。VRS 根据四级评估疼痛：无、轻度、中度和重度。疼痛评估在两个时间点进行：当患者在到达术后护理单元（PACU）后足够清醒以进行交流时和到达 PACU 后 30 分钟时。使用组内相关系数（ICC）评估评分之间的一致性水平。通过受试者工作特征曲线确定切点。
VAS、NRS 和 FPS-R 之间的 ICC 始终较高（0.839-0.945）。疼痛类别如下：VAS 中轻度≦5.3/中度 5.4-7.1/重度≧7.2，NRS 中轻度≦5/中度 6-7/重度≧8，FPS-R 中轻度≦4/中度 6/重度 8 和 10。需要镇痛药物的切点为 VAS≧5.5、NRS≧6、FPS-R≧6 和 VRS≧2（中度或重度疼痛）。
在术后即刻期间，VAS、NRS 和 FPS-R 相关性良好。轻度和中度疼痛之间的边界约为 10 分制的 5 分，这与镇痛请求的切点相对应。医疗保健提供者应考虑 VRS 和其他患者特定体征，以避免疼痛治疗不足或阿片类药物过量。
