A survey of post-craniotomy analgesia in British neurosurgical centres: time for perceptions and prescribing to change?
A survey of post-craniotomy analgesia in British neurosurgical centres: time for perceptions and prescribing to change?
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DOI：
10.1080/02688690903100595
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发表时间：
2009-01-01
影响因子：
1.1
通讯作者：
Solth, A.
中科院分区：
文献类型：
--
作者：
Kotak, D.;Cheserem, B.;Solth, A.
接受开颅手术的患者术后可能会经历中度到重度的疼痛。在国王学院医院对开颅术后患者的止痛审计显示，一些患者的止痛处方不同，止痛效果不佳。在引入正式的术后止痛制度之前，对英国境内的成人神经外科进行了调查，以确定是否对开颅术后疼痛管理达成了普遍共识。被问及以下问题：是否有标准化的止痛方案/方案；使用了哪种一线、二线、三线和四线止痛药；是否使用了非类固醇抗炎药；首选的止吐剂是什么；是否定期评估疼痛。我们还对我们机构内的神经外科医生、神经麻醉师、重症医生和神经外科高度依赖护士进行了调查，以确定他们对开颅术后疼痛的看法。所有31个成人神经外科病房都接受了调查。23%(7个单位)有标准化的止痛方案/方案，65%(20个单位)术后常规评估疼痛。70%的单位使用磷酸可待因或二氢可待因(22单位)作为一线阿片类药物，其他30%的单位使用吗啡(9单位)。曲马多用量占42%(13个单位)，3个单位采用病人自控镇痛。除5个单位(16%)外，所有单位都开出了常规扑热息痛。52%(16)的单位使用非类固醇抗炎药；在使用非类固醇抗炎药的单位中，19%(3/16)的单位定期开出处方。其中一个单元使用了可乐定输液。除两个病房外，所有病房均按要求开出止吐药。45%的单位一线止吐药物为环丙嗪，29%的单位为恩丹西酮，16%的单位为甲氧氯普胺。目前，在英国的神经外科中心，对于开颅手术后的疼痛管理还没有达成共识。除非有足够有力的随机对照研究来解决主要的安全性和有效性问题，否则这一领域的进展将仍然缓慢。
Patients undergoing craniotomy may experience moderate to severe pain postoperatively. An audit of analgesia of post-craniotomy patients at King's College Hospital demonstrated variable analgesic prescribing practices and suboptimal analgesia in some patients. Prior to introducing a formal post-operative analgesic regime, a survey of the adult neurosurgical units within the United Kingdom was undertaken to ascertain whether there was a general consensus regarding post-craniotomy pain management. Questions were asked as to whether there was a standardized analgesic regime/protocol; which first, second, third, and fourth-line analgesics were used; whether non-steroidal anti-inflammatory drugs were used; what the preferred anti-emetic was; and whether pain was routinely assessed. We also undertook a survey of neurosurgeons, neuroanaesthetists, intensivists, and neurosurgery high dependency nurses within our institution to ascertain what their perceptions were of post-craniotomy pain. All 31 adult neurosurgical units were surveyed. Twenty three percent (7 units) had a standardized analgesic regime/protocol and 65% routinely assessed pain post-operatively (20 units). Seventy percent of units used codeine phosphate or dihydrocodeine (22 units) as the first line opioid the other 30% using morphine (9 units). Forty two percent (13 units) used tramadol; patient controlled analgesia was used in 3 units. Regular paracetamol was prescribed in all but five (16%) units. Fifty two percent of units (16) used NSAIDs; of those that used NSAIDs 19% (3/16) prescribed them regularly. One unit used clonidine infusions. Anti-emetics were prescribed as required in all but two units. Cyclizine was the first-line anti-emetic in 45% of the units, ondansetron in 29% and metoclopramide in 16%. There is currently no consensus on pain management after craniotomy in neurosurgical centres in the UK. Until there are sufficiently powered randomized controlled studies to address the main safety and efficacy issues progress in this area will remain slow.