Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan.
Department of Medical Research, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan.
BMC Anesthesiol. 2021 Mar 19;21(1):85. doi: 10.1186/s12871-021-01303-y.
Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient's self-anticipated pain score before surgery, and compared the anticipated scores with the actual pain levels and analgesic requirements after surgery.
This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numeric rating scale, NRS 0-10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ≥4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain that required more aggressive intervention.
A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.523, 95% confidence interval 1.126-2.061; P = 0.006). Patients who took regular benzodiazepine at bedtime (P = 0.037) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P < 0.05). Higher anticipated pain scores (preoperative NRS ≥ 4) were associated with higher actual postoperative pain levels (P = 0.007) in the PACU and higher total equivalent opioid use (P < 0.001) for acute pain management during the perioperative period.
This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient's satisfaction.
目前术后疼痛管理的原则主要基于手术类型和范围。本临床研究测量了患者术前自我预期疼痛评分，并将预期评分与术后实际疼痛水平和镇痛需求进行了比较。
本前瞻性观察性研究招募了 2018 年 6 月至 8 月在台湾义大医院接受择期手术的连续患者。患者在术前麻醉评估期间被要求主观评估他们对预定手术干预的最高预期疼痛程度（数字评分量表，NRS 0-10）。手术后，记录患者在麻醉后恢复室（PACU）中经历的实际疼痛强度（NRS 0-10）以及围手术期内给予的阿片类药物总剂量。NRS 评分≥4 被认为是预期或术后疼痛的不可接受水平，需要更积极的干预。
共有 996 例患者纳入研究。大多数患者（86%）接受全身麻醉，其中 73.9%有既往手术史。女性预期的总体疼痛强度明显高于男性患者（调整后的优势比 1.523，95%置信区间 1.126-2.061；P=0.006）。睡前常规服用苯二氮䓬类药物的患者（P=0.037）和计划接受更具侵入性手术的患者最有可能在术前阶段预期更高的疼痛强度（P<0.05）。较高的预期疼痛评分（术前 NRS≥4）与 PACU 中更高的实际术后疼痛水平（P=0.007）和围手术期内急性疼痛管理中更高的总等效阿片类药物使用量（P<0.001）相关。
本观察性研究发现，女性、睡前常规使用苯二氮䓬类药物和计划接受更具侵入性手术的患者预期与手术相关的疼痛明显更高。因此，需要对这些患者进行适当的术前镇痛控制咨询和对夸大的疼痛预期的管理，以提高提供的麻醉质量和患者满意度。
