Shyu Margaret, Robinson Tyler P, Morgan Allison M, Johnson Julie K, Shan Ying, Bilimoria Karl Y, Yang Anthony D
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
Surgical Outcomes and Quality Improvement Center(SOQIC), Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States of America.
Surg Open Sci. 2024 Jun 18;20:98-100. doi: 10.1016/j.sopen.2024.06.001. eCollection 2024 Aug.
Subcutaneous injection of unfractionated heparin (UH) or low molecular weight heparin (LMWH) is frequently utilized for venous thromboembolism chemoprophylaxis. We previously discovered that nurses believe patients experience more pain with UH compared to the LMWH enoxaparin; however, no published studies that are appropriately powered exist comparing pain associated with subcutaneous chemoprophylaxis. Our objective was to assess if differences exist in pain associated with subcutaneous administration of UH and enoxaparin. We conducted an observational study of patients who underwent major abdominal surgery between 11/2017-4/2019. All patients received one of three prophylactic regimens: (1) UH only, (2) Initial dose of UH followed by enoxaparin, or (3) enoxaparin only. Of the 74 patients observed, 40 patients received UH followed by enoxaparin, 17 received UH only, and 17 received enoxaparin only. There was a significant difference in patients' mean perceived pain between subcutaneous UH and enoxaparin injections (mean post-injection pain after UH 3.3 vs. enoxaparin 1.5; < 0.001). There was no significant difference in perceived pain for patients who received consecutive UH or enoxaparin injections. Differences in pain associated with different chemoprophylaxis agents may be an unrecognized driver of patient refusals of VTE chemoprophylaxis and may lead to worse VTE outcomes.
皮下注射普通肝素（UH）或低分子肝素（LMWH）常用于静脉血栓栓塞的化学预防。我们之前发现，护士们认为与低分子肝素依诺肝素相比，患者使用普通肝素时疼痛更明显；然而，尚无足够样本量的已发表研究比较皮下化学预防相关的疼痛情况。我们的目的是评估皮下注射普通肝素和依诺肝素时疼痛是否存在差异。我们对2017年11月至2019年4月期间接受腹部大手术的患者进行了一项观察性研究。所有患者接受以下三种预防方案之一：（1）仅使用普通肝素，（2）初始剂量普通肝素后使用依诺肝素，或（3）仅使用依诺肝素。在观察的74例患者中，40例患者先接受普通肝素后接受依诺肝素，17例仅接受普通肝素，17例仅接受依诺肝素。皮下注射普通肝素和依诺肝素后患者的平均疼痛感受存在显著差异（普通肝素注射后平均疼痛评分为3.3，依诺肝素为1.5；<0.001）。连续接受普通肝素或依诺肝素注射的患者在疼痛感受上无显著差异。不同化学预防药物相关的疼痛差异可能是患者拒绝接受VTE化学预防未被认识到的原因，并且可能导致更差的VTE结局。
