Multimodal smerteundersøgelse i patienter med fri klap

Randomiseret kontrolleret prospektivt forsøg for at sammenligne to standarder for pleje til hoved- og nakkekirurgi smertebehandling. Arm A, vil omfatte:

• Planlagt Tylenol 1000 mg IV éngangsdosis intraoperativt, derefter 650 mg via PEG-rør eller PO Q4H til en maksimal dosis på 4gm/24 timer
• Opioider prn baseret på numerisk smerteskala (0-10, hvor 0 indikerer ingen smerte og 10 indikerer værste smerte nogensinde):
• 0-3: ingen prn meds, tryghed, lyt til musik, se tv.
• 4-7: Oxycodon 5 mg q4h prn via PEG-rør eller PO med maksimalt 30 mg/24 timer.
• 8-10 Morfin 2 mg IV q2h prn gennembrudssmerter.

Arm B, vil omfatte:

• Arm En beskrivelse med tilføjelse..
• Planlagt Ketorolac med start efter operation dag #1, 15 mg hver 6. time (maks. 120 mg/dag), i alt 5 dage
• Planlagt Gabapentin starter 7 dage før operationen for at fortsætte postoperativt
• Regional blokering pr. anæstesiprotokol - Indledende blokering: 0,5 % bupivacain, 20 ml Kontinuerlig infusion: 0,125 % bupivacain ved 6 ml/time med en 5 ml bolus tilgængelig hvert 30. minut

Pain was measured on a Likert scale from 0 to 10 (i.e. 0 being the lowest and 10 being the greatest amount of pain). Baseline pain (P0) was measured on this scale for each patient in the preoperative setting. Pain was similarly assessed at regular intervals post-operatively during hospitalization (Pn).

Patient pain percentage was subsequently defined as follows:

{ 100*[(P_n/P_0) -1]│ n∈N, n≥1}

Where:

P_0: the baseline (initial) measurement taken at time t=0. P_n: the measurement taken at the nth time interval after baseline, where n∈N, n≥1

Interpretation of "pain percentage compared to baseline":

• A value of 0% indicates no change from baseline pain
• Negative values indicate lower pain than baseline
• Positive values indicate higher pain than baseline
• Therefore, lower values represent a better outcome and higher values represent a worse outcome

Each of the domain of ABC pain index is weighted (mult_D) based on relative importance.

For each domain D ∈{sleep, lying, sitting, oob, walk}, let:

D_able∈{1,2,3}, (1 = able with pain; 2 = unable due to pain; 3 = unable for other reasons) D_pain∈[0, 5] (reported pain score)

Then if:

D_able = 1 numerator_D = D_pain × mult_D denominator_D = 1 +(5×mult_D) D_able=2 numerator_D = 1 + (5×mult_D) denominator_D= 1 + (5×mult_D ) D_able=3 numerator_D = 1 denominator_D = 1

For the site-specific domains D ∈{h&n,flap,graft}, let:

D_present∈{1,2} (1=present; 2=absent) D_pain∈[0, 5] (reported pain score)

Then if:

D_present=1:

numerator_D = D_pain × mult_D denominator_D = 5 × mult_D

D_present=2:

numerator_D = 0 denominator_D = 0

Patient Pain Assessment Percentage:

ABC_numerator = sum(numerator_D) ABC_denominator = sum(denominator_D) ABC_percentage = ABC_numerator / ABC_denominator This ranges from 0-100%. Lower values are better, higher values are worse.