游离皮瓣患者的多模式疼痛研究

随机对照前瞻性试验，比较头颈手术疼痛管理的两种护理标准。 A组，将包括：

• 预定泰诺 1000 mg IV 一次，术中给药，然后通过 PEG 管或 PO Q4H 给药 650 mg，最大剂量为 4gm/24 小时
• 基于数字疼痛量表（0-10，0 表示没有疼痛，10 表示有史以来最严重的疼痛）的阿片类药物 prn：
• 0-3：不服用 prn 药物，放心，听音乐，看电视。
• 4-7：羟考酮 5 mg q4h prn 通过 PEG 管或 PO 最多 30 mg/24 小时。
• 8-10 吗啡 2 mg IV q2h prn 爆发性疼痛。

B组，将包括：

• 手臂 A 描述与附加..
• 预定的酮咯酸从术后第 1 天开始，每 6 小时 15 毫克（最多 120 毫克/天），总共 5 天
• 计划在术前 7 天开始服用加巴喷丁，以在术后继续
• 根据麻醉方案进行区域阻滞 - 初始阻滞：0.5% 布比卡因，20 毫升 连续输注：0.125% 布比卡因，6 毫升/小时，每 30 分钟推注 5 毫升

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.