Personalization over Protocolization.
Personalization over Protocolization.
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个性化优于协议化。
DOI：
10.1097/aln.0000000000003695
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发表时间：
2021-03-01
期刊：
影响因子：
8.8
通讯作者：
Muehlschlegel JD
中科院分区：
文献类型：
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作者：
Schreiber KL;Muehlschlegel JD
据估计，全世界每年进行2.4亿例手术。1国际疼痛研究协会将2017年命名为“术后疼痛年”，强调了急性和慢性术后疼痛的问题。尽管认识不断提高，临床前文献中对术后疼痛机制基础的研究也有悠久的历史，2以及针对该问题的所有ERAS方案，但急性术后疼痛仍然是大量患者的问题。之前的大型研究（22，000例患者）表明，28%的患者在手术后仍会出现中度至重度急性疼痛，3更高的疼痛轨迹与更频繁地返回急诊室和再次入院相关。4在这一期的《麻醉学》中，Vasilopoulos等人5报道了他们对接受重大非心脏手术后7天内患者术后疼痛轨迹的经验性辨别。观察疼痛轨迹与单个时间点或随时间推移的平均疼痛评分（曲线下面积）的重要性在于，它代表了患者在护理期间的疼痛体验，以图形方式可视化疼痛的时间过程，包括其稳定性和解决方案的感觉，并允许更完整地了解镇痛益处。作为执业麻醉师，我们直觉地知道，人们从手术中恢复的方式是多样的，而且不是双峰的（做得好，做得不好）。
An estimated 240 million surgeries are performed worldwide each year. 1 The International Association for the Study of Pain named 2017 the “Year of Pain After Surgery,” highlighting the problem of acute and chronic postsurgical pain. Despite this increased recognition, as well as a longstanding history of excellent study of the mechanistic underpinnings of postsurgical pain in the preclinical literature, 2 and all the ERAS protocols that have been thrown at this problem, acute postsurgical pain remains a problem for a substantial number of patients. Previous larger studies (22,000 patients) suggest that 28% of patients still experience moderate-severe acute pain after surgery, 3 and higher pain trajectories have been associated with more frequent returns to the emergency department and readmission. 4In this issue of Anesthesiology, Vasilopoulos et al. 5 report their empiric discrimination of the postoperative pain trajectories of patients in the seven days after undergoing major elective non-cardiac surgery. The importance of looking at pain trajectory vs a single point in time, or an average pain scores over time (area under the curve), is that it represents a patient’s pain experience over the duration of their care, graphically visualizing the time course of pain, including a sense of its stability and resolution, and allowing a more complete overall picture of analgesic benefit. As practicing anesthesiologists, we intuitively know that there is diversity in how people recover from surgery and that it is not bimodal (doing well, doing poorly).