Prospective evaluation of pain and analgesic use following major elective intracranial surgery
Prospective evaluation of pain and analgesic use following major elective intracranial surgery
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DOI：
10.3171/jns.2007.106.2.210
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发表时间：
2007-02-01
影响因子：
4.1
通讯作者：
Yaster, Myron
中科院分区：
文献类型：
--
作者：
Gottschalk, Allan;Berkow, Lauren C.;Yaster, Myron
Object.颅内大手术后的阿片类药物给药通常受到假定缺乏需求和阿片类药物会对术后神经系统检查产生不利影响的担忧的限制。作者进行了一项前瞻性研究，以评估接受大型颅内手术的患者术后疼痛的发生率、严重程度和治疗。187例患者（77例男性和110例女性，平均年龄52 ± 15岁，平均体重78.1 ± 19.9 kg）接受了幕上（129例患者）或幕下（58例患者）手术。69%的患者报告在术后第1天出现中度至重度疼痛（0-10量表上>= 4）。术后第2天，48%的患者疼痛评分大于或等于4分。大约80%的患者在术后第1天接受对乙酰氨基酚治疗，而58%的患者接受阿片类药物（主要是静脉芬太尼）治疗。与接受幕上手术的患者相比，接受幕下手术的患者在术后第1天静息时（平均评分4.9 +/- 2.2与3.8 +/- 2.6; p = 0.015）和运动时（平均评分6.3 +/- 2.6与4.5 +/- 2.7; p < 0.001）的疼痛更严重。在术后第1天和第2天，接受幕下手术的患者接受了更大量的阿片类药物（p 0.019）和非阿片类药物（p
Object. Opioid administration after major intracranial surgery is often limited by a presumed lack of need and a concern that opioids will adversely affect the postoperative neurological examination. The authors conducted a prospective study to evaluate the incidence, severity, and treatment of postoperative pain in patients who underwent major intracranial surgery.Methods. One hundred eighty-seven patients (77 men and 110 women, mean age 52 +/- 15 years, mean weight 78.1 +/- 19.9 kg) underwent either supratentorial (129 patients) or infratentorial (58 patients) procedures. Sixty-nine percent of the patients reported experiencing moderate to severe pain (>= 4 on a 0-10 scale) during the 1st postoperative day. Pain scores greater than or equal to 4 persisted in 48% on the 2nd postoperative day. Approximately 80% of patients were treated with acetaminophen on the 1st postoperative day, whereas opioids (primarily intravenous fentanyl) were administered to 58%. Compared with patients who underwent supratentorial procedures, those who underwent infratentorial procedures reported more severe pain at rest (mean score 4.9 +/- 2.2 compared with 3.8 +/- 2.6; p = 0.015) and with movement (mean score 6.3 +/- 2.6 compared with 4.5 +/- 2.7; p < 0.001) on the 1st postoperative day. On both the 1st and 2nd postoperative days, patients who underwent infratentorial procedures received greater quantities of opioid (p 0.019) and nonopioid (p