分娩镇痛：你还满意吗？

本文由“小麻哥的日常"授权转载

摘要译文（供参考）

分娩期间和分娩后急性疼痛治疗满意度的决定因素

背景：

产科的一项重要任务是为患者提供阴道分娩（VD）和剖宫产（CS）后的适当疼痛管理。

目的：

本分析的目的是评估产后第二天、VD后3个月和6个月以及CS后女性的疼痛强度。此外，还计划确定VD和CS后产妇对急性疼痛治疗满意度的决定因素。

方法：

这项单中心前瞻性队列研究的二次分析包括210名产妇。

这些妇女在维尔茨堡大学医院分娩。

他们在分娩前（P）、第一天（D1）、VD和CS后3个月和6个月完成了一项调查。

这项调查包括关于预期疼痛、经历的疼痛、出生后的疼痛以及心理问卷的问题。此外，还从患者记录中收集信息。

择期CS患者接受椎管麻醉。

在硬膜外、脊麻或全身麻醉下进行二次CS。

病房的疼痛治疗是标准化的。

主要结果是休息时、运动时的急性和慢性疼痛强度、疼痛治疗满意度的决定因素以及在VD和CS期间和之后接受更多疼痛药物的意愿（D1）。

结果：

共有175名女性在所有时间点完成了调查，可用于分析（退出16.8%）。

结果证实，CS后D1的疼痛程度较高（运动期间的疼痛强度中值：8 NRS点，四分位间距，IQR 6-9点）。

VD后疼痛评分低得多（运动期间疼痛强度中值：4分，IQR 2-5分）。

在母亲中，7.4%在VD或CS后的所有时间点都报告了休息时的疼痛，但在3个月和6个月后疼痛强度较低（休息时的平均疼痛强度：2分，IQR 0-3分），28%在CS后接受了缓释阿片类药物，33%的妇女（VD和CS）使用了硬膜外麻醉。

CS或VD后疼痛治疗满意度降低的最重要影响因素是疼痛缓解不足。

有硬膜外镇痛的VD患者在分娩期间比没有硬膜外镇痛患者更满意，但在D1时没有差异。

讨论：

本研究证实CS后急性疼痛水平较高，慢性疼痛发生率约为7%，但疼痛强度较低，三分之一的患者在CS后服用了强效阿片类药物。

约11%的初次CS后妇女（8%的硬膜外，3%的脊髓/硬膜外联合）和约55%的二次CS后妇女有硬膜外镇痛，可用于产后疼痛治疗。

没有硬膜外镇痛或没有阿片类药物的女性可能没有良好的疼痛管理。

可接受的疼痛缓解似乎是满意度和希望接受更多疼痛药物的最相关的预测因素。

与未使用硬膜外镇痛的母亲相比，VD母亲对分娩期间的疼痛治疗更满意。

因此，更好的多模式疼痛管理（包括阿片类、硬膜外和非阿片类）可能提供更好的疼痛缓解，并可能提高CS后疼痛治疗的总体满意度。

最后，与单独的疼痛强度相比，可接受的疼痛缓解可能是分娩后疼痛治疗满意度的更好的与患者相关的结果指标。

关键词：

分娩；硬膜外镇痛；产科；术后疼痛；满意

原文摘要

Determinants of satisfaction with acute pain therapy during and after childbirth

Background: 

An important task in obstetrics is to offer patients adequate pain management after vaginal delivery (VD) and after cesarean section (CS). The aim of the present analysis was to assess pain intensity at the day after childbirth, after 3 and 6 months in women after VD and after CS. Additionally, it was planned to identify determinants of maternal satisfaction with acute pain therapy following VD and CS.

Methods: 

This secondary analysis of a single-center prospective cohort study included 210 parturients. The women gave birth in the University Hospital of Wuerzburg. They completed a survey before childbirth (P), on the first day (D1), 3 and 6 months after VD and CS. The survey included questions about the expected pain, the experienced pain, the birth, the pain afterwards and also psychological questionnaires. In addition, information was collected from the patient records. Women with planned CS received spinal anesthesia. A secondary CS was performed with an epidural, spinal or general anesthesia. Pain therapy on the ward was standardized. The primary outcomes were acute and chronic pain intensity at rest, during movement, determinants of satisfaction with pain therapy and the wish to have received more pain medication during and after VD and CS (D1).

Results: 

A total of 175 women completed the survey at all time points and were available for the analysis (drop-out 16.8%). The results confirmed high pain levels at D1 after CS (median pain intensity during movement: 8 NRS points, interquartile range, IQR 6-9 points). After VD pain scores were much lower (median pain intensity during movement: 4 points, IQR 2-5 points). Of the mothers 7.4% reported pain at rest at all time points after VD or CS but pain intensity was low after 3 and 6 months (median pain intensity at rest: 2 points, IQR 0-3 points), 28% received extended-release opioids after CS and 33% of women (VD and CS) had an epidural. The most important influencing factor for lower satisfaction with pain therapy after CS or VD was inadequate pain relief. Women with VD who had an epidural, were more satisfied during delivery than women without but there was no difference at D1.

Discussion: 

This study confirmed high acute pain levels following CS and an incidence of chronic pain of around 7% but pain intensity was low and one third received strong opioids after CS. Around 11% of women after primary CS (8% epidural, 3% combined spinal/epidural) and around 55% of women after secondary CS had an epidural, which could be used for pain therapy after birth. Women without an epidural or without opioids may not have had good pain management. The received pain relief appeared to be the most relevant predictor for satisfaction and the wish to have received more pain medication. Mothers having a VD with an epidural catheter were more satisfied with pain therapy during birth than those without. Therefore, a better multimodal pain management (including opioids, epidural and nonopioids) might provide better pain relief and might improve overall satisfaction with pain treatment following CS. Finally, the received pain relief might be a better patient-related outcome measure for satisfaction with pain treatment after childbirth than pain intensity alone.

Keywords: 

Delivery; Epidural analgesia; Obstetrics; Postoperative pain; Satisfaction.

免责声明：

本微信公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

—END—    

编辑：MiLu.米鹭

校对：Michel.米萱

打赏