使用标准化疼痛管理方法通过区域麻醉主要肢体截肢患者的疼痛管理方法
Sarah Meadowcroft1, Johnny Gayden2, Suzanna Fitzpatrick1
1University of Maryland Medical Center, 22 South Greene Street Baltimore, MD, USA.
概括
一种新的方法来治疗大肢体截肢 (MLA) 患者的疼痛,显著减少了阿片类药物使用 (MME). 虽然停留时间和疼痛得分没有改善,但这种正式的框架增强了MLA患者的复杂疼痛管理.
科学领域:
- 血管外科 血管外科
- 疼痛管理 疼痛管理
- 提高质量 提高质量
背景情况:
- 主要肢体截肢 (MLA) 患者经历复杂的疼痛,通常没有标准化的方法来管理.
- 以前的治疗导致了高阿片类药物消费 (平均2,352.2MME) 和长时间住院治疗 (平均21天).
研究的目的:
- 实施一种正式的临床途径来管理MLA患者的疼痛.
- 为符合条件的MLA患者确保基于证据的区域麻醉 (RA) 的一致应用.
主要方法:
- 提供者评估了疼痛评分,并对患者进行了RA分组,如果疼痛显著 (NPS ≥4).
- 用一个检查清单来确保流程完成,并通过QR码调查障碍.
- 图表审计跟踪了MME,NPS和停留时间 (LOS).
主要成果:
- 在11名MLA中,64%报告有明显的疼痛,57%接受了RA.
- 手术后的一天,NPS有所改善 (4.7至3.2),但在出院后增加 (至5).
- 总MME下降了~65% (平均842.5MME),尽管LOS增加到28.4天.
结论:
- 这种新方法大大减少了MLA患者的MME.
- 虽然LOS和NPS没有改善,但该框架有效地管理复杂的疼痛.
- 未来的努力应集中在RA的提供者教育和改进过渡到口腔疼痛治疗方案.
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