PDF(Pubmed)
Abstract：
Subcutaneous injection of unfractionated heparin (UH) or low molecular weight heparin (LMWH) is frequently utilized for venous thromboembolism chemoprophylaxis. We previously discovered that nurses believe patients experience more pain with UH compared to the LMWH enoxaparin; however, no published studies that are appropriately powered exist comparing pain associated with subcutaneous chemoprophylaxis. Our objective was to assess if differences exist in pain associated with subcutaneous administration of UH and enoxaparin. We conducted an observational study of patients who underwent major abdominal surgery between 11/2017-4/2019. All patients received one of three prophylactic regimens: (1) UH only, (2) Initial dose of UH followed by enoxaparin, or (3) enoxaparin only. Of the 74 patients observed, 40 patients received UH followed by enoxaparin, 17 received UH only, and 17 received enoxaparin only. There was a significant difference in patients\' mean perceived pain between subcutaneous UH and enoxaparin injections (mean post-injection pain after UH 3.3 vs. enoxaparin 1.5; p < 0.001). There was no significant difference in perceived pain for patients who received consecutive UH or enoxaparin injections. Differences in pain associated with different chemoprophylaxis agents may be an unrecognized driver of patient refusals of VTE chemoprophylaxis and may lead to worse VTE outcomes.
摘要：
普通肝素（UH）或低分子量肝素（LMWH）的皮下注射通常用于静脉血栓栓塞的化学预防。我们以前发现，护士认为与LMWH依诺肝素相比，UH患者的疼痛更多；然而，没有发表的具有适当功效的研究比较了皮下化学预防相关的疼痛.我们的目的是评估与皮下施用UH和依诺肝素相关的疼痛是否存在差异。我们对2017年11月至2019年4月接受腹部大手术的患者进行了一项观察性研究。所有患者均接受三种预防方案之一：（1）仅UH，（2）UH的初始剂量，然后是依诺肝素，或（3）仅依诺肝素。在观察到的74名患者中，40名患者接受了UH，然后接受了依诺肝素，17只收到UH，17只接受了依诺肝素。皮下UH和依诺肝素注射的患者平均感觉疼痛有显著差异(UH3.3后平均注射后疼痛与依诺肝素1.5；p<0.001）。连续接受UH或依诺肝素注射的患者在感知疼痛方面没有显着差异。与不同化学预防药物相关的疼痛差异可能是患者拒绝VTE化学预防的未被识别的驱动因素，并可能导致更差的VTE结局。
