Pain Intensity on the First Day after Surgery A Prospective Cohort Study Comparing 179 Surgical Procedures
Pain Intensity on the First Day after Surgery A Prospective Cohort Study Comparing 179 Surgical Procedures
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DOI：
10.1097/aln.0b013e31828866b3
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发表时间：
2013-04-01
期刊：
影响因子：
8.8
通讯作者：
Meissner, Winfried
中科院分区：
文献类型：
--
作者：
Gerbershagen, Hans J.;Aduckathil, Sanjay;Meissner, Winfried
背景：手术后的严重疼痛仍然是一个主要问题，发生在20-40%的患者中。尽管有许多已发表的研究，但在日常临床实践中，许多类型的手术后的疼痛程度尚不清楚。为了提高术后疼痛治疗和开发程序的具体，优化的疼痛治疗协议，手术类型，可能会导致严重的术后疼痛，在日常practice.Methods：本研究考虑了115,775例患者从578外科病房在105家德国医院。共有70，764例患者符合入选标准。在术后第一天，要求患者评定自手术以来的最严重疼痛强度（数字评定量表，0-10）。所有外科手术被分配到529个明确定义的组。当一个组包含少于20名患者时，数据被排除在分析之外。最后，来自179个手术组的50,523名患者进行了比较。结果：40个疼痛评分最高的手术（中位数数字评分，6-7）包括22个四肢矫形/创伤手术。患者在许多“小”手术后报告了高疼痛评分，包括阑尾切除术、胆囊切除术、痔疮切除术和扁桃体切除术，这些手术在25种疼痛强度最高的手术中排名。一些“重大”腹部手术导致相对较低的疼痛评分，往往是因为足够的硬膜外analges.Conclusions：几个常见的小到中等水平的外科手术，包括一些腹腔镜方法，导致意外的高水平的术后疼痛。为了减少遭受严重疼痛的患者数量，应该更密切地监测接受所谓小手术的患者，术后疼痛治疗需要遵守现有的特定程序疼痛治疗建议。
Background: Severe pain after surgery remains a major problem, occurring in 20-40% of patients. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain therapy and develop procedure-specific, optimized pain-treatment protocols, types of surgery that may result in severe postoperative pain in everyday practice must first be identified.Methods: This study considered 115,775 patients from 578 surgical wards in 105 German hospitals. A total of 70,764 patients met the inclusion criteria. On the first postoperative day, patients were asked to rate their worst pain intensity since surgery (numeric rating scale, 0-10). All surgical procedures were assigned to 529 well-defined groups. When a group contained fewer than 20 patients, the data were excluded from analysis. Finally, 50,523 patients from 179 surgical groups were compared.Results: The 40 procedures with the highest pain scores (median numeric rating scale, 6-7) included 22 orthopedic/trauma procedures on the extremities. Patients reported high pain scores after many "minor" surgical procedures, including appendectomy, cholecystectomy, hemorrhoidectomy, and tonsillectomy, which ranked among the 25 procedures with highest pain intensities. A number of "major" abdominal surgeries resulted in comparatively low pain scores, often because of sufficient epidural analgesia.Conclusions: Several common minor- to medium-level surgical procedures, including some with laparoscopic approaches, resulted in unexpectedly high levels of postoperative pain. To reduce the number of patients suffering from severe pain, patients undergoing so-called minor surgery should be monitored more closely, and postsurgical pain treatment needs to comply with existing procedure-specific pain-treatment recommendations.