■在剖腹产后作为多模式镇痛策略一部分的连续伤口输注导管的作用尚不清楚。我们在多模式镇痛方案中引入了连续伤口输注导管,以评估对剖腹产后镇痛结果的影响。
■机构审查委员会(IRB)批准后,一项为期4个月的实践变革作为一项质量改进举措。除了多模式镇痛,对于所有接受剖腹产的女性,隔周使用长达3天的连续伤口输注导管.主要结果是术后住院阿片类药物的消耗。次要结果是24和72h时的静态和动态疼痛评分,直到第一次镇痛请求的时间,阿片类药物相关的副作用,逗留时间,满意度(0-100%),和持续伤口输液导管相关并发症。
■所有计划在4个月内进行剖腹产的妇女(n=139)均纳入分析,70名妇女接受了持续的伤口输液导管,对照组为69。阿片类药物消耗量(持续伤口导管输注组11.3[7.5-61.9]mg吗啡当量与对照组30.0[11.3-48.8]mg吗啡当量),疼痛评分(除了24h静息疼痛评分高于对照组2[1-3],高于伤口连续输注导管组的1.5[0-3];P=0.05),副作用,逗留时间,两组并发症相似。使用连续伤口输注导管24h时的满意度得分更高(100%[91-100%]vs90%[86-100%];P=0.003),72h时无差异。一名患者表现出全身局部麻醉毒性症状,无明显伤害。
■在剖腹产后疼痛管理的多模式镇痛方案中添加连续伤口输注导管显示出最小的临床显著镇痛益处。需要进一步的研究来探索在可能从这种干预中受益最多的人群中使用连续伤口输注导管。
UNASSIGNED: The role of continuous wound infusion catheters as part of a multimodal analgesia strategy after Caesarean delivery is unclear. We introduced continuous wound infusion catheters to our multimodal analgesia regimen to evaluate the impact on analgesic outcomes after Caesarean delivery.
UNASSIGNED: After institutional review board (IRB) approval, a 4-month practice change was instituted as a quality improvement initiative. In addition to multimodal analgesia, continuous wound infusion catheters for up to 3 days were offered on alternate weeks for all women undergoing Caesarean deliveries. The primary outcome was postoperative in-hospital opioid consumption. Secondary outcomes were static and dynamic pain scores at 24 and 72 h, time until first analgesic request, opioid-related side-effects, length of stay, satisfaction (0-100%), and continuous wound infusion catheter-related complications.
UNASSIGNED: All women scheduled for Caesarean delivery (n=139) in the 4-month period were included in the analysis, with 70 women receiving continuous wound infusion catheters, and 69 in the control group. Opioid consumption (continuous wound infusion catheter group 11.3 [7.5-61.9] mg morphine equivalents vs control group 30.0 [11.3-48.8] mg morphine equivalents), pain scores (except 24 h resting pain scores which were higher in the control group 2 [1-3] vs 1.5 [0-3] in the continous wound infusion catheters group; P=0.05), side-effects, length of stay, and complications were similar between groups. Satisfaction scores at 24 h were higher with continuous wound infusion catheters (100% [91-100%] vs 90% [86-100%]; P=0.003) with no differences at 72 h. One patient demonstrated symptoms of systemic local anaesthetic toxicity which resolved without significant harm.
UNASSIGNED: The addition of continuous wound infusion catheters to a multimodal analgesia regimen for post-Caesarean delivery pain management demonstrated minimal clinically significant analgesic benefits. Future studies are needed to explore the use of continuous wound infusion catheters in populations that may benefit most from this intervention.