背景:心脏病手术后疼痛无处不在,优化管理很重要。尽管如此,有很大的实践差异。为了解决这个问题,儿科急性护理心脏病学合作组织致力于制定本临床实践指南。
方法:由儿科心脏病专家组成的专家小组,先进的实践从业者,药剂师,一位小儿心胸外科医生,并召集了一位小儿心脏麻醉师。在文献中搜索相关文章,合作网站提交了针对中心的术后疼痛管理方案。使用改进的Delphi技术,产生了建议,并通过迭代的Delphi轮达成共识。
结果:60项建议达成共识,包含在本指南中。他们解决了指导方针的使用,疼痛评估,一般考虑,术前考虑,术中注意事项,区域麻醉,阿片类药物,保留阿片类药物,非阿片类药物,非药物疼痛管理,和排放考虑。
结论:尽管有大量的文献和特定于中心的方案,但心脏手术后儿童的术后疼痛目前是一个具有显著实践变异性的领域。本指南中包含的建议的核心是理想的疼痛管理从术前咨询开始并持续到患者出院的概念。总的来说,支持建议的证据质量较低.在这一领域有持续的研究需求,特别是在儿科人群中。
BACKGROUND: Pain following surgery for cardiac disease is ubiquitous, and optimal management is important. Despite this, there is large practice variation. To address this, the Paediatric Acute Care Cardiology Collaborative undertook the effort to create this clinical practice
guideline.
METHODS: A panel of experts consisting of paediatric cardiologists, advanced practice practitioners, pharmacists, a paediatric cardiothoracic surgeon, and a paediatric cardiac anaesthesiologist was convened. The literature was searched for relevant articles and Collaborative sites submitted centre-specific protocols for postoperative pain management. Using the modified Delphi technique, recommendations were generated and put through iterative Delphi rounds to achieve
consensus.
RESULTS: 60 recommendations achieved
consensus and are included in this
guideline. They address
guideline use, pain assessment, general considerations, preoperative considerations, intraoperative considerations, regional anaesthesia, opioids, opioid-sparing, non-opioid medications, non-pharmaceutical pain management, and discharge considerations.
CONCLUSIONS: Postoperative pain among children following cardiac surgery is currently an area of significant practice variability despite a large body of literature and the presence of centre-specific protocols. Central to the recommendations included in this
guideline is the concept that ideal pain management begins with preoperative counselling and continues through to patient discharge. Overall, the quality of evidence supporting recommendations is low. There is ongoing need for research in this area, particularly in paediatric populations.