Nurs Womens Health. 2022 Oct;26(5):344-352. doi: 10.1016/j.nwh.2022.07.009. Epub 2022 Sep 7.
To compare opioid use and pain scores in women who had scheduled cesarean birth before and after implementing a scheduled nonopioid analgesia practice guideline.
Quality improvement project with a comparison of pre-/postintervention.
SETTING/LOCAL PROBLEM: A 170-bed community hospital where the administration of postcesarean pain medications was unstandardized.
Convenience sample of 175 individuals who were scheduled for cesarean birth (106 in preintervention group and 69 in postimplementation group).
INTERVENTION/MEASUREMENTS: All participants had received a dose of 150 mcg of intrathecal morphine intraoperatively. Care of participants in the postimplementation group included a new practice guideline using preoperative oral acetaminophen 1 g and postoperative intravenous ketorolac 30 mg that transitioned to ibuprofen 600 mg orally every 6 hours until discharge. Acetaminophen 1 g every 6 hours also continued until discharge. For breakthrough pain, oxycodone 5 mg to 10 mg was available.
Results were analyzed using the chi-square and t test. There was a statistical difference in the mean milligram morphine equivalent consumed after scheduled cesarean birth (preintervention = 21.15 vs. postintervention = 3.91, p < .001). Postimplementation, 84.1% of participants did not consume any opioids beyond the intrathecal dose compared to 47.2% of participants preintervention. Mean pain scores decreased from 2.49 to 1.62 (p < .001), and there was an observed decrease of the highest reported pain score from 5.39 to 4.03 (p < .001).
The results of this project support the current literature indicating that the administration of a scheduled nonopioid multimodal analgesia regimen to individuals with scheduled cesarean birth is an effective postoperative pain management strategy. This approach to managing surgical birth pain can decrease subjective reports of pain and overall opioid consumption during the hospital stay.
比较实施计划性非阿片类镇痛实践指南前后行择期剖宫产女性的阿片类药物使用情况和疼痛评分。
前后干预比较的质量改进项目。
地点/问题背景：一家 170 床位的社区医院，其剖宫产术后疼痛药物管理不规范。
175 名择期行剖宫产的便利样本（干预前组 106 例，实施后组 69 例）。
干预/测量：所有参与者均在术中接受 150 mcg 鞘内吗啡。实施后组患者接受新的实践指南治疗，包括术前口服 1 g 对乙酰氨基酚和术后静脉注射 30 mg 酮咯酸，然后转为每 6 小时口服 600 mg 布洛芬，直至出院。每 6 小时也继续给予对乙酰氨基酚。对于突破性疼痛，可使用 5-10 mg 羟考酮。
使用卡方检验和 t 检验分析结果。计划性剖宫产术后阿片类药物的平均吗啡等效消耗量有统计学差异（干预前：21.15 mg，干预后：3.91 mg，p <.001）。实施后，84.1%的患者在鞘内剂量之外不再使用任何阿片类药物，而干预前组这一比例为 47.2%。疼痛评分从 2.49 降至 1.62（p <.001），最高报告疼痛评分从 5.39 降至 4.03（p <.001）。
本项目结果支持当前文献表明，对计划性剖宫产患者给予计划性非阿片类多模式镇痛方案是一种有效的术后疼痛管理策略。这种管理剖宫产术后疼痛的方法可以减少主观疼痛报告和住院期间的总体阿片类药物消耗。
