Dauber A, Ure B M, Neugebauer E, Schmitz S, Troidl H
Abteilung für Anästhesiologie und Intensivmedizin des Städtischen Krankenhauses München-Schwabing.
Anaesthesist. 1993 Jul;42(7):448-54.
Knowledge of the incidence and significance of postoperative pain is essential for the establishment of effective pain treatment programmes. Detailed investigations on the incidence, severity and quality of postoperative pain from the surgeon's perspective are scarce in German hospitals. It was the aim of our study to investigate postoperative pain in general surgery under routine conditions. PATIENTS AND METHODS. A total of 168 patients scheduled for abdominal, vascular and orthopaedic surgery were investigated in a prospective trial. Pain was assessed by means of a 100-point visual analogue scale (VAS), a 5-point verbal rating scale (VRS), the original version of the McGill Pain Questionnaire (MPQ) and the short form of the McGill Pain Questionnaire (SFMPQ). These were applied preoperatively and daily thereafter up to the 7th postoperative day. Patients were randomly assigned into two groups with different sequences of application of the instruments. The pain treatment programme included intravenous analgesia with tramadol/metamizol (max. tramadol 400 mg+metamizol 5 g in any 24 h) after major surgery and additional administration of piritramide as needed (max. 60 mg/24 h.i.v.). After minor surgery ibuprofen was routinely given for analgesia (3 x 500 mg). RESULTS. All patients had pain on the days 1 and 2 postoperatively. The mean intensity of pain was 44 VAS points on day 1 and 6.8 points on day 7. The mean intensity of pain measured by the VRS on the 1st postoperative day was between "mild" and "moderate". The quality of pain showed a constant pattern concerning the mean scale values of descriptors of each subgroup (sensory, evaluative, affective, mixed) for both the original and the short form of the McGill Pain Questionnaire up to the 7th postoperative day. Sensory descriptors were reported more frequently than affective descriptors. Typical pain patterns were identified for different operations. After subtotal thyroidectomy, for example, patients perceived a high intensity of pain of short duration. In contrast, patients still have a high intensity of pain up to 7 days after abdominal and rectal operations. CONCLUSIONS. We conclude from our results that patients perceive significant postoperative pain under current standardized pain treatment in our department. Effective programmes for pain relief should take account of the different patterns of pain after different operations, as identified in this study.
了解术后疼痛的发生率及其重要性对于制定有效的疼痛治疗方案至关重要。在德国医院，从外科医生的角度对术后疼痛的发生率、严重程度和性质进行详细调查的研究较少。我们研究的目的是在常规条件下调查普通外科手术后的疼痛情况。患者与方法。在一项前瞻性试验中，对总共168例计划进行腹部、血管和骨科手术的患者进行了调查。通过100分视觉模拟量表（VAS）、5分语言评定量表（VRS）、原始版麦吉尔疼痛问卷（MPQ）和麦吉尔疼痛问卷简表（SFMPQ）对疼痛进行评估。这些评估在术前以及术后每天进行，直至术后第7天。患者被随机分为两组，采用不同的仪器应用顺序。疼痛治疗方案包括大手术后静脉注射曲马多/安乃近（最大剂量：曲马多400mg + 安乃近5g/24小时），并根据需要额外给予匹利卡明（最大剂量：60mg/24小时静脉注射）。小手术后常规给予布洛芬镇痛（3次，每次500mg）。结果。所有患者在术后第1天和第2天均有疼痛。疼痛的平均强度在术后第1天为44 VAS分，在第7天为6.8分。术后第1天通过VRS测量的疼痛平均强度介于“轻度”和“中度”之间。对于原始版和简版麦吉尔疼痛问卷，直至术后第7天，每个亚组（感觉、评价、情感、混合）描述词的平均量表值所显示的疼痛性质呈现出恒定模式。感觉描述词的报告频率高于情感描述词。针对不同手术确定了典型的疼痛模式。例如，甲状腺次全切除术后，患者感觉到高强度的短暂疼痛。相比之下，腹部和直肠手术后，患者在长达7天的时间内仍有高强度疼痛。结论。我们从研究结果得出结论，在我们科室目前的标准化疼痛治疗下，患者会感觉到明显的术后疼痛。有效的疼痛缓解方案应考虑到本研究中确定的不同手术术后的不同疼痛模式。
