Ayres Jack M, Dallman Johnathan, Nolte Jack A, Higginbotham Nicholas, Baker Jordan, Horton Greg, Salava Jonathon, Sojka John, Templeton Kimberly J, Malancea Radu Ioan, Heddings Archie
Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS.
Department of Orthopedic Surgery, Spitalul Judetean de Urgenta Mavromati Botosani, Botosani, Romania.
Kans J Med. 2023 Feb 21;16(1):56-60. doi: 10.17161/kjm.vol16.18744. eCollection 2023.
Opioids play a crucial role in post-operative pain management in America, but not in some other countries. We sought to determine if a discrepancy in opioid use between the United States (U.S.) and Romania, a country that administers opioids in a conservative fashion, would show in subjective pain control differences.
Between May 23, 2019, and November 23, 2019, 244 Romanian patients and 184 American patients underwent total hip arthroplasty or the surgical treatment of the following fractures: bimalleolar ankle, distal radius, femoral neck, intertrochanteric, and tibial-fibular. Opioid and non-opioid analgesic medication use and subjective pain scores during the first and second 24 hours after surgery were analyzed.
Subjective pain scores for the first 24 hours were higher among patients in Romania compared to the U.S. (p < 0.0001), but Romanians reported lower pain scores than U.S. patients in the second 24-hours (p < 0.0001). The quantity of opioids given to U.S. patients did not differ significantly based on sex (p = 0.4258) or age (p = 0.0975). However, females reported higher pain scores than male patients following the studied procedures (p = 0.0181). No sex-based differences in pain scores were noted among Romanian patients.
Higher pain scores in American females, despite equivalent amounts of narcotics to their male counterparts, and the absence of a difference in Romanians suggested that the current American post-operative pain regimen may be tailored to the needs of male patients. In addition, it pointed to the impacts of gender, compared to sex, in pain experiences. Future research should look for the safest, most efficacious pain regimen suitable for all patients.
在美国，阿片类药物在术后疼痛管理中起着至关重要的作用，但在其他一些国家并非如此。我们试图确定美国和罗马尼亚之间阿片类药物使用的差异（罗马尼亚以保守方式使用阿片类药物）是否会体现在主观疼痛控制差异上。
在2019年5月23日至2019年11月23日期间，244名罗马尼亚患者和184名美国患者接受了全髋关节置换术或以下骨折的手术治疗：双踝骨折、桡骨远端骨折、股骨颈骨折、转子间骨折和胫腓骨骨折。分析了术后头24小时和第二个24小时内阿片类和非阿片类镇痛药物的使用情况以及主观疼痛评分。
罗马尼亚患者术后头24小时的主观疼痛评分高于美国患者（p<0.0001），但罗马尼亚患者在第二个24小时报告的疼痛评分低于美国患者（p<0.0001）。给予美国患者的阿片类药物数量在性别上无显著差异（p = 0.4258），在年龄上也无显著差异（p = 0.0975）。然而，接受研究手术的女性患者报告的疼痛评分高于男性患者（p = 0.0181）。罗马尼亚患者中未发现基于性别的疼痛评分差异。
尽管美国女性患者使用的麻醉剂剂量与男性相当，但她们的疼痛评分更高，而罗马尼亚患者没有这种差异，这表明当前美国的术后疼痛治疗方案可能是根据男性患者的需求制定的。此外，这指出了性别（与生理性别相对）对疼痛体验的影响。未来的研究应寻找适合所有患者的最安全、最有效的疼痛治疗方案。
