Multimodal smertestudie hos pasienter med fri klaff

Randomisert kontrollert prospektiv studie for å sammenligne to standarder for omsorg for smertebehandling av hode- og nakkekirurgi. Arm A, vil inkludere:

• Planlagt Tylenol 1000 mg IV engangsdose intraoperativt, deretter 650 mg via PEG-rør eller PO Q4H til en maksimal dose på 4gm/24 timer
• Opioider prn basert på numerisk smerteskala (0-10, hvor 0 indikerer ingen smerte og 10 indikerer verste smerte noensinne):
• 0-3: ingen prn meds, trygghet, lytt til musikk, se på TV.
• 4-7: Oksykodon 5 mg q4t prn via PEG-rør eller PO med maksimalt 30 mg/24 timer.
• 8-10 Morfin 2 mg IV q2t prn gjennombruddssmerter.

Arm B, vil inkludere:

• Arm En beskrivelse med tillegg..
• Planlagt Ketorolac som starter postoperativ dag #1, 15 mg q6t (maks 120 mg/dag), i totalt 5 dager
• Planlagt Gabapentin starter 7 dager preoperativt for å fortsette postoperativt
• Regional blokkering per anestesiprotokoll - Innledende blokkering: 0,5 % bupivakain, 20 ml Kontinuerlig infusjon: 0,125 % bupivakain med 6 ml/time med en 5 ml bolus tilgjengelig hvert 30. minutt

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.