Education or sedation? A randomized clinical trial of impact on procedural pain and satisfaction during regional block placement, and the moderating effect of pain catastrophizing.
Yun-Yun Kathy Chen, Jenna M Wilson, Sheila R Gokul, Patrick W Collins, Martin Kiik, Kamen Vlassakov, Kristin L Schreiber
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引用次数: 0
Abstract
Background: Preoperative peripheral nerve block placement can involve both procedural pain and psychological distress, which practitioners treat using both sedation and education/reassurance. The experience of pain may be potently modulated by baseline pain catastrophizing (presence of rumination, magnification, and helplessness). This randomized clinical trial assessed whether the treatment effect of sedation vs education/reassurance on procedural nerve block pain and satisfaction varied for patients with different baseline pain catastrophizing scores.
Methods: At baseline, patients completed the Pain Catastrophizing Scale (PCS), were stratified into low-PCS (<10) or high-PCS (≥10) groups, and then randomized to receive sedation or education/reassurance during nerve block placement. Patients reported maximum and average procedural pain and satisfaction, immediately after the procedure and recalled in the postanesthesia care unit (PACU). Generalized estimating equations examined main effects of treatment and baseline PCS group on maximum procedural pain and the interaction between them.
Results: Maximal procedural pain immediately after the procedure was similar between treatment groups (n=72), but a significant treatment×PCS group interaction (B=0.8, 95% CI (0.04, 1.5), p=0.04) indicated that among patients with high PCS, sedation was associated with less pain (2.3±2.2 vs 4.3±2.5, p=0.01). Exploratory findings indicate sedation being associated with lower recalled procedural pain in PACU than education/reassurance (0.3±0.7 vs 2.2±2.4, p<0.001), and education being associated with higher satisfaction among those with lower PCS.
Discussion: Our findings suggest that patients with high PCS may disproportionately benefit from sedation during nerve block, reporting less pain, whereas patients with low PCS may have a slight preference for education/reassurance, reporting higher satisfaction.
背景：术前周围神经阻滞置入可能涉及程序性疼痛和心理困扰，从业者使用镇静和教育/安抚来治疗。疼痛体验可能被基线疼痛灾难化（反刍、放大和无助的存在）强有力地调节。本随机临床试验评估镇静与教育/安慰对不同基线疼痛灾难评分患者的程序性神经阻滞疼痛和满意度的治疗效果是否不同。方法：在基线时，完成疼痛灾难量表（PCS）的患者被分层为低PCS(结果：手术后立即最大手术疼痛在治疗组之间相似（n=72），但显著的treatment×PCS组相互作用（B=0.8, 95% CI (0.04, 1.5), p=0.04）表明，在高PCS患者中，镇静与较轻的疼痛相关（2.3±2.2 vs 4.3±2.5,p=0.01）。探索性研究结果表明，与教育/安抚相比，镇静与PACU中较低的回忆性程序性疼痛相关（0.3±0.7 vs 2.2±2.4）。讨论：我们的研究结果表明，在神经阻滞期间，高PCS患者可能从镇静中获益更多，报告的疼痛更少，而低PCS患者可能更倾向于教育/安抚，报告的满意度更高。试验注册号：NCT05579509。
期刊介绍：
Regional Anesthesia & Pain Medicine, the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA), is a monthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications.
Published for over thirty years, this respected journal also serves as the official publication of the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society for Regional Anesthesia (AFSRA), and the Academy of Regional Anaesthesia of India (AORA).
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