背景:对肩袖疾病或肱骨关节炎导致的慢性中度至重度肩痛患者进行适当的术前治疗可能会改善手术和患者预后,但是这方面的公开证据很少。因此,基于专家共识的术前干预建议可作为指导.
方法:进行了一项Delphi研究,以根据国家专家共识制定术前管理算法。在使用PRISMA标准对过去10年发表的相关文献进行系统审查之后,科学委员会开发了Delphi问卷。它由48个陈述组成,分为五个块(I.术前疼痛的评估/诊断;II.术前功能/社会心理方面;III.治疗目标;IV.治疗;V.随访/转诊),邀请了来自全国各地的28名经验丰富的肩部外科医生来回答。
结果:所有参与者在第一轮中回答了Delphi问卷,在第二轮中回答了25个(邀请的89.3%)。总的来说,46/49最后声明达成共识,在此基础上,科学委员会定义了最终的术前管理算法。首先,外科医生应评估肩痛的强度和特征,使用特定的经过验证的问卷,肩膀功能和心理社会方面。术前治疗目标应包括肩痛控制,抑郁症/夜间睡眠改善,阿片类药物消费调整和停止药物滥用。术后肩痛减轻程度或功能改善/生活质量的目标应与患者达成一致。术前慢性中度至重度肩痛的治疗应包括非药物和药物干预。肩痛程度的随访,这些患者的治疗依从性和心理健康状况可以由外科团队(外科医生和麻醉师)与初级保健团队一起进行。肩痛程度非常剧烈的患者可以转诊至疼痛科,遵循特定的协议。
结论:根据全国专家共识,确定了因肩袖疾病或肱骨关节炎而接受手术治疗的慢性中度至重度肩痛患者的术前管理方法。要点包括全面的患者管理,从客观评估肩痛和功能开始,生活质量,术前和术后治疗目标的建立,个性化治疗干预和多学科患者随访的处方。对临床实践实施这些建议可能会导致更好的术前肩痛管理和更成功的手术结果和患者满意度。
BACKGROUND: Appropriate preoperative management of patients with chronic moderate to severe shoulder pain who are candidates for surgery owing to rotator cuff disease or glenohumeral osteoarthritis may improve surgery and patient outcomes, but published evidence in this regard is scarce. Therefore, the availability of recommendations on preoperative interventions based on expert
consensus may serve as guidance.
METHODS: A Delphi study was conducted to develop a preoperative management algorithm based on a national expert
consensus. A Delphi questionnaire was developed by a scientific committee following a systematic review of the relevant literature published during the past 10 years using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) criteria. It consisted of 48 statements divided into 5 blocks (block I, assessment and diagnosis of preoperative pain; block II, preoperative function and psychosocial aspects; block III, therapeutic objectives; block IV, treatment; and block V, follow-up and referral), and 28 experienced shoulder surgeons from across the country were invited to answer.
RESULTS: All participants responded to the Delphi questionnaire in the first round, and 25 responded in the second round (89.3% of those invited). Overall, 46 of 49 final statements reached a
consensus, on the basis of which a final preoperative management algorithm was defined by the scientific committee. First, surgeons should assess shoulder pain intensity and characteristics, shoulder functionality, and psychosocial aspects using specific validated questionnaires. Preoperative therapeutic objectives should include shoulder pain control, depression and/or nocturnal sleep improvement, opioid consumption adjustment, and substance abuse cessation. Postoperative objectives regarding the degree of shoulder pain reduction or improvement in functionality and/or quality of life should be established in agreement with the patient. Treatment of preoperative chronic moderate to severe shoulder pain should comprise nonpharmacologic as well as pharmacologic interventions. Follow-up of the shoulder pain levels, treatment adherence, and mental health status of these patients may be carried out by the surgical team (surgeon and anesthesiologist) together with the primary care team. Patients with very intense shoulder pain levels may be referred to a pain unit following specific protocols.
CONCLUSIONS: A preoperative management algorithm for patients with chronic moderate to severe shoulder pain who are candidates for surgery owing to rotator cuff disease or glenohumeral osteoarthritis was defined based on a national expert
consensus. Main points include comprehensive patient management starting with an objective assessment of shoulder pain and function, as well as quality of life; establishment of preoperative and postoperative therapeutic targets; prescription of individualized therapeutic interventions; and multidisciplinary patient follow-up. Implementation of these recommendations into clinical practice may result in better preoperative shoulder pain management and more successful surgical outcomes and patient satisfaction.