BMJ:全麻期间播放治疗建议对术后疼痛和阿片类药物使用的影响:多中心随机对照试验

2020
12/18

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单盲随机对照研究。

护理SCI晨读:

全麻期间播放治疗建议对术后疼痛和阿片类药物使用的影响:多中心随机对照试验

 

 


 

 


摘要

目的: 探讨手术中通过耳机对患者播放治疗建议对术后疼痛和阿片类药物使用的影响。

设计: 单盲随机对照研究。

地点: 德国的五家三级医院。

参与者: 2018年1月至12月连续招募400名患者中的385名,他们在全身麻醉下接受了1-3小时的手术。根据方案分析,干预组包括191名患者,对照组194名。

干预措施: 干预措施包括录制背景音乐和基于催眠治疗原理的积极建议,在全麻期间通过耳机反复播放20分钟,然后保持沉默10分钟。对照组的患者分配空白录音。

主要结局指标: 主要结局指标是在术后24小时内由患者进行自控镇痛或由护士自控镇痛的药物剂量以及根据患者对疼痛强度的定期评估(数值范围为0-10,数值越高,代表疼痛越严重)。

结果: 与对照组相比,干预组在手术后24小时内需要的阿片类药物剂量显著降低(P = 0.002),其中吗啡当量的中位数为4.0毫克(四分位数范围为0-8),而阿片类药物的中位数为5.3(2-12),并且效应大小(Cohen d)为0.36(95%置信区间0.16至0.56)。干预组术后需要阿片类药物的患者人数显著减少(P = 0.001):干预组中191名患者中的121名(63%,95%CI:45%至70%)vs 对照组194名中155名患者(80%,95%CI:74%至85%)。避免术后阿片类药物的Number to Treat为6。干预组在手术后24小时内疼痛评分持续且显著降低,平均降低25%。没有不良反应的报道。

结论: 在全身麻醉期间通过耳机播放的治疗建议可提供一种安全、可行、便宜且非药物的技术,以减轻术后疼痛和阿片类药物的使用,并有可能被更广泛地使用。根据大量患者对术中知觉的发现,外科医生和麻醉师应注意手术过程中的背景噪音和谈话内容。

 


 

 


英文摘要

Abstract

Objective: To investigate the effect of therapeutic suggestions played to patients through earphones during surgery on postoperative pain and opioid use.

Design: Blinded randomised controlled study.

Setting: Five tertiary care hospitals in Germany.

Participants: 385 of 400 patients consecutively recruited from January to December 2018 who were to undergo surgery for 1-3 hours under general anaesthesia. In the per protocol analysis 191 patients were included in the intervention group and 194 patients in the control group.

Intervention: The intervention comprised an audiotape of background music and positive suggestions based on hypnotherapeutic principles, which was played repeatedly for 20 minutes followed by 10 minutes of silence to patients through earphones during general anaesthesia. Patients in the control group were assigned to a blank tape.

Main outcome measures: The main outcome was dose of opioid administered by patient controlled analgesia or nurse controlled analgesia within the first postoperative 24 hours, based on regular evaluation of pain intensity on a numerical rating scale (range 0-10, with higher scores representing more severe pain).

Results: Compared with the control group, the intervention group required a significantly (P=0.002) lower opioid dose within 24 hours after surgery, with a median of 4.0 mg (interquartile range 0-8) morphine equivalents versus 5.3 (2-12), and an effect size (Cohen's d) of 0.36 (95% confidence interval 0.16 to 0.56). The number of patients who needed opioids postoperatively was significantly (P=0.001) reduced in the intervention group: 121 of 191 (63%, 95% confidence interval 45% to 70%) patients in the intervention group versus 155 of 194 (80%, 74% to 85%) in the control group. The number needed to treat to avoid postoperative opioids was 6. Pain scores were consistently and significantly lower in the intervention group within 24 hours after surgery, with an average reduction of 25%. No adverse events were reported.

Conclusions: Therapeutic suggestions played through earphones during general anaesthesia could provide a safe, feasible, inexpensive, and non-drug technique to reduce postoperative pain and opioid use, with the potential for more general use. Based on the finding of intraoperative perception by a considerable number of patients, surgeons and anaesthetists should be careful about background noise and conversations during surgery.

 

原文链接:

https://www.bmj.com/content/371/bmj.m4284.long



 

 

本文由作者自行上传,并且作者对本文图文涉及知识产权负全部责任。如有侵权请及时联系(邮箱:nanxingjun@hmkx.cn
关键词:
阿片类,全麻,药物,试验,治疗,影响,干预,手术

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