Dusica Stamenkovic, Philipp Baumbach, Dragana Radovanovic, Milos Novovic, Nebojsa Ladjevic, Emilija Dubljanin Raspopovic, Ivan Palibrk, Dragana Unic-Stojanovic, Aleksandra Jukic, Radmilo Jankovic, Suzana Bojic, Jasna Gacic, Ulrike M Stamer, Winfried Meissner, Ruth Zaslansky
{"title":"围手术期疼痛管理包是可行的：疼痛登记的结果。","authors":"Dusica Stamenkovic, Philipp Baumbach, Dragana Radovanovic, Milos Novovic, Nebojsa Ladjevic, Emilija Dubljanin Raspopovic, Ivan Palibrk, Dragana Unic-Stojanovic, Aleksandra Jukic, Radmilo Jankovic, Suzana Bojic, Jasna Gacic, Ulrike M Stamer, Winfried Meissner, Ruth Zaslansky","doi":"10.1097/AJP.0000000000001153","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>The quality of postoperative pain management is often poor. A \"bundle,\" a small set of evidence-based interventions, is associated with improved outcomes in different settings. We assessed whether staff caring for surgical patients could implement a \"Perioperative Pain Management Bundle\" and whether this would be associated with improved multidimensional pain-related patient-reported outcomes (PROs).</p><p><strong>Methods: </strong>\"PAIN OUT,\" a perioperative pain registry, offers tools for auditing pain-related PROs and obtaining information about perioperative pain management during the first 24 hours after surgery. Staff from 10 hospitals in Serbia used this methodology to collect data at baseline. They then implemented the \"Perioperative Pain Management Bundle\" into the clinical routine and collected another round of data. The bundle consists of 4 treatment elements: (1) a full daily dose of 1 to 2 nonopioid analgesics (eg, paracetamol and/or nonsteroidal anti-inflammatory drugs), (2) at least 1 type of local/regional anesthesia, (3) pain assessment by staff, and (4) offering patients information about pain management. The primary endpoint was a multidimensional pain composite score (PCS), evaluating pain intensity, interference, and side effects that was compared between patients who received the full bundle versus not.</p><p><strong>Results: </strong>Implementation of the complete bundle was associated with a significant reduction in the PCS ( P < 0.001, small-medium effect size [ES]). When each treatment element was evaluated independently, nonopioid analgesics were associated with a higher PCS (ie, poorer outcome, and negligible ES), and the other elements were associated with a lower PCS (all negligible small ES). Individual PROs were consistently better in patients receiving the full bundle compared with 0 to 3 elements. The PCS was not associated with the surgical discipline.</p><p><strong>Discussion: </strong>We report findings from using a bundle approach for perioperative pain management in patients undergoing mixed surgical procedures. Future work will seek strategies to improve the effect.</p>","PeriodicalId":50678,"journal":{"name":"Clinical Journal of Pain","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":"{\"title\":\"The Perioperative Pain Management Bundle is Feasible: Findings From the PAIN OUT Registry.\",\"authors\":\"Dusica Stamenkovic, Philipp Baumbach, Dragana Radovanovic, Milos Novovic, Nebojsa Ladjevic, Emilija Dubljanin Raspopovic, Ivan Palibrk, Dragana Unic-Stojanovic, Aleksandra Jukic, Radmilo Jankovic, Suzana Bojic, Jasna Gacic, Ulrike M Stamer, Winfried Meissner, Ruth Zaslansky\",\"doi\":\"10.1097/AJP.0000000000001153\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>The quality of postoperative pain management is often poor. A \\\"bundle,\\\" a small set of evidence-based interventions, is associated with improved outcomes in different settings. We assessed whether staff caring for surgical patients could implement a \\\"Perioperative Pain Management Bundle\\\" and whether this would be associated with improved multidimensional pain-related patient-reported outcomes (PROs).</p><p><strong>Methods: </strong>\\\"PAIN OUT,\\\" a perioperative pain registry, offers tools for auditing pain-related PROs and obtaining information about perioperative pain management during the first 24 hours after surgery. Staff from 10 hospitals in Serbia used this methodology to collect data at baseline. They then implemented the \\\"Perioperative Pain Management Bundle\\\" into the clinical routine and collected another round of data. The bundle consists of 4 treatment elements: (1) a full daily dose of 1 to 2 nonopioid analgesics (eg, paracetamol and/or nonsteroidal anti-inflammatory drugs), (2) at least 1 type of local/regional anesthesia, (3) pain assessment by staff, and (4) offering patients information about pain management. The primary endpoint was a multidimensional pain composite score (PCS), evaluating pain intensity, interference, and side effects that was compared between patients who received the full bundle versus not.</p><p><strong>Results: </strong>Implementation of the complete bundle was associated with a significant reduction in the PCS ( P < 0.001, small-medium effect size [ES]). When each treatment element was evaluated independently, nonopioid analgesics were associated with a higher PCS (ie, poorer outcome, and negligible ES), and the other elements were associated with a lower PCS (all negligible small ES). Individual PROs were consistently better in patients receiving the full bundle compared with 0 to 3 elements. The PCS was not associated with the surgical discipline.</p><p><strong>Discussion: </strong>We report findings from using a bundle approach for perioperative pain management in patients undergoing mixed surgical procedures. 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The Perioperative Pain Management Bundle is Feasible: Findings From the PAIN OUT Registry.
Objectives: The quality of postoperative pain management is often poor. A "bundle," a small set of evidence-based interventions, is associated with improved outcomes in different settings. We assessed whether staff caring for surgical patients could implement a "Perioperative Pain Management Bundle" and whether this would be associated with improved multidimensional pain-related patient-reported outcomes (PROs).
Methods: "PAIN OUT," a perioperative pain registry, offers tools for auditing pain-related PROs and obtaining information about perioperative pain management during the first 24 hours after surgery. Staff from 10 hospitals in Serbia used this methodology to collect data at baseline. They then implemented the "Perioperative Pain Management Bundle" into the clinical routine and collected another round of data. The bundle consists of 4 treatment elements: (1) a full daily dose of 1 to 2 nonopioid analgesics (eg, paracetamol and/or nonsteroidal anti-inflammatory drugs), (2) at least 1 type of local/regional anesthesia, (3) pain assessment by staff, and (4) offering patients information about pain management. The primary endpoint was a multidimensional pain composite score (PCS), evaluating pain intensity, interference, and side effects that was compared between patients who received the full bundle versus not.
Results: Implementation of the complete bundle was associated with a significant reduction in the PCS ( P < 0.001, small-medium effect size [ES]). When each treatment element was evaluated independently, nonopioid analgesics were associated with a higher PCS (ie, poorer outcome, and negligible ES), and the other elements were associated with a lower PCS (all negligible small ES). Individual PROs were consistently better in patients receiving the full bundle compared with 0 to 3 elements. The PCS was not associated with the surgical discipline.
Discussion: We report findings from using a bundle approach for perioperative pain management in patients undergoing mixed surgical procedures. Future work will seek strategies to improve the effect.
期刊介绍：
The Clinical Journal of Pain explores all aspects of pain and its effective treatment, bringing readers the insights of leading anesthesiologists, surgeons, internists, neurologists, orthopedists, psychiatrists and psychologists, clinical pharmacologists, and rehabilitation medicine specialists. This peer-reviewed journal presents timely and thought-provoking articles on clinical dilemmas in pain management; valuable diagnostic procedures; promising new pharmacological, surgical, and other therapeutic modalities; psychosocial dimensions of pain; and ethical issues of concern to all medical professionals. The journal also publishes Special Topic issues on subjects of particular relevance to the practice of pain medicine.
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