Optimising pain management protocols following cardiac surgery: A protocol for a national quality improvement study

IF 1.1 Q3 SURGERY
S. Jayakumar , M. Borrelli , Z. Milan , G. Kunst , D. Whitaker
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引用次数: 11

Abstract

Pain following cardiac surgery is a multifaceted phenomenon resulting from a number of mechanisms. High-levels of post-operative pain are associated with cardiovascular and respiratory complications and adequate pain management is crucial for enabling fast recovery. However, adequate pain control is complex, a challenge that stems from a combination of poor reporting of pain, significant variation amongst patients and the side-effects of strong, particularly opioid, analgesics. An initial audit at our hospital demonstrated high-levels of post-operative pain following cardiac surgery and a protocol was therefore devised by the anaesthetic department for cardiac surgical pain management. The protocol stratified patients into high- or low-risk of pain based on the presence of risk factors for pain and utilised a combination of pre-operative one-off dose of gabapentin, intra-operative opioid infusion and post-operative multimodal analgesia with paracetamol, weak and strong opioids. Additionally, patients at high-risk of pain also received patient controlled analgesia. Use of this protocol was associated with improved pain scores on the first three post-operative days. We have devised this study to test for reproducibility of the benefit experienced at our hospital at a larger multicentre level. After acquiring pre-existing post-operative pain management strategies through an initial survey, local study leads will undertake a baseline audit. Local study leads will then lead a 4-week period of protocol implementation. Trusts with official pain management protocols will be given the option to re-circulate their pre-existing protocols. Subsequently, pain scores during post-operative days 1–3 will be re-audited.

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优化心脏手术后疼痛管理方案:一项国家质量改进研究的方案
心脏手术后的疼痛是一个多方面的现象,由许多机制引起。高水平的术后疼痛与心血管和呼吸系统并发症有关,适当的疼痛管理对于实现快速恢复至关重要。然而,充分的疼痛控制是复杂的,这是一项挑战,源于疼痛报告不佳,患者之间存在显著差异以及强效,特别是阿片类镇痛药的副作用。我们医院的初步审核表明心脏手术后疼痛程度很高,因此麻醉科制定了心脏手术疼痛管理方案。该方案根据存在的疼痛危险因素将患者分为高风险或低风险疼痛,并采用术前一次性加巴喷丁、术中阿片类药物输注和术后对乙酰氨基酚、弱和强阿片类药物的多模式镇痛的组合。此外,对疼痛高危患者也给予患者自控镇痛。该方案的使用与术后前三天疼痛评分的改善有关。我们设计了这项研究,以在更大的多中心水平上测试我们医院所经历的益处的可重复性。在通过初步调查获得预先存在的术后疼痛管理策略后,当地研究负责人将进行基线审计。然后,当地研究负责人将领导为期4周的协议实施。拥有官方疼痛管理协议的信托机构将有权重新发布其已有的协议。随后复查术后1-3天疼痛评分。
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来源期刊
自引率
0.00%
发文量
12
期刊介绍: IJS Protocols is the first peer-reviewed, international, open access journal seeking to publish research protocols across across the full breadth of the surgical field. We are aim to provide rapid submission to decision times whilst maintaining a high quality peer-review process.
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