Bacher Tobias, Ewers Andre
Uniklinik für Anästhesiologie, perioperative Medizin und allg. Intensivmedizin, LKH Salzburg, Universitätsklinikum der Paracelsus Medizinischen Privatuniversität Salzburg (PMU), Müllner Hauptstr. 48, 5020, Salzburg, Österreich.
Institut für Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich.
Schmerz. 2024 Oct;38(5):328-334. doi: 10.1007/s00482-023-00698-6. Epub 2023 Feb 7.
Patient-controlled analgesia (PCA) is a well-established form of postoperative pain management. One form of administration is patient-controlled regional analgesia (PCRA), where local anesthetics are administered via peripheral regional catheters; however, a prerequisite is that the patients are instructed on its use. A multitude of sources recommend that these instructions are given before surgery as preoperative training on pain management procedures has been shown to significantly reduce patients' postoperative pain and increase their well-being.
The aim was to assess the effect of guideline-assisted preoperative patient education for PCRA on postoperative pain in patients undergoing orthopedic surgery compared to unstructured postoperative standard instructions.
A controlled study with two randomized samples and a postinterventional survey was conducted. Overall, 73 patients with PCRA catheters for orthopedic surgery were enrolled in the study. The 37 participants in the interventional group (IG) received guideline-based structured instructions on PCRA use as well as a handout immediately before the surgical intervention. The 36 patients in the control group (CG) received postoperative instructions in the anesthesia recovery room. Pain was documented according to the numerical rating scale (NRS) at 2h (t1), 6h (t2), and 24h (t3) after surgery.
There were no statistically significant differences in the average pain scores between the two groups; however, there were lower mean pain scores in the IG at t1 and t3.
A significant reduction of pain in the IG could not be shown. Further studies concerning this topic with larger samples and adapted points in time are recommended.
患者自控镇痛（PCA）是一种成熟的术后疼痛管理方式。其中一种给药形式是患者自控区域镇痛（PCRA），即通过外周区域导管给予局部麻醉药；然而，前提是要指导患者如何使用。众多资料表明，由于术前进行疼痛管理程序培训已被证明能显著减轻患者术后疼痛并提高其舒适度，所以应在手术前给予这些指导。
旨在评估与无组织的术后标准指导相比，针对PCRA的指南辅助术前患者教育对骨科手术患者术后疼痛的影响。
进行了一项有两个随机样本的对照研究及干预后调查。总体而言，73例接受骨科手术并留置PCRA导管的患者纳入研究。干预组（IG）的37名参与者在手术干预前即刻接受了基于指南的PCRA使用结构化指导以及一份资料手册。对照组（CG）的36例患者在麻醉恢复室接受术后指导。术后2小时（t1）、6小时（t2）和24小时（t3）根据数字评分量表（NRS）记录疼痛情况。
两组之间的平均疼痛评分无统计学显著差异；然而，干预组在t1和t3时的平均疼痛评分较低。
未显示干预组疼痛有显著减轻。建议针对该主题进行更大样本量和调整时间点的进一步研究。
