现在的位置: 首页时讯速递, 进展交流>正文
[BMJ圣诞专刊]: 全麻期间治疗提示对术后疼痛及阿片类药物使用的影响:多中心随机对照试验
2021年01月13日 时讯速递, 进展交流 暂无评论

Research Christmas 2020: Dr Strange

Effect of therapeutic suggestions during general anaesthesia on postoperative pain and opioid use: multicentre randomised controlled trial

Hartmuth Nowak, Nina Zech, Sven Asmussen, et al

BMJ 2020; 371: m4284 doi: https://doi.org/10.1136/bmj.m4284 (Published 10 December 2020)

Abstract

Objective

To investigate the effect of therapeutic suggestions played to patients through earphones during surgery on postoperative pain and opioid use.

Design

Blinded randomised controlled study.

Setting

Five tertiary care hospitals in Germany.

Participants

385 of 400 patients consecutively recruited from January to December 2018 who were to undergo surgery for 1-3 hours under general anaesthesia. In the per protocol analysis 191 patients were included in the intervention group and 194 patients in the control group.

Intervention

The intervention comprised an audiotape of background music and positive suggestions based on hypnotherapeutic principles, which was played repeatedly for 20 minutes followed by 10 minutes of silence to patients through earphones during general anaesthesia. Patients in the control group were assigned to a blank tape.

Main outcome measures

The main outcome was dose of opioid administered by patient controlled analgesia or nurse controlled analgesia within the first postoperative 24 hours, based on regular evaluation of pain intensity on a numerical rating scale (range 0-10, with higher scores representing more severe pain).

Results

Compared with the control group, the intervention group required a significantly (P=0.002) lower opioid dose within 24 hours after surgery, with a median of 4.0 mg (interquartile range 0-8) morphine equivalents versus 5.3 (2-12), and an effect size (Cohen’s d) of 0.36 (95% confidence interval 0.16 to 0.56). The number of patients who needed opioids postoperatively was significantly (P=0.001) reduced in the intervention group: 121 of 191 (63%, 95% confidence interval 45% to 70%) patients in the intervention group versus 155 of 194 (80%, 74% to 85%) in the control group. The number needed to treat to avoid postoperative opioids was 6. Pain scores were consistently and significantly lower in the intervention group within 24 hours after surgery, with an average reduction of 25%. No adverse events were reported.

Conclusions

Therapeutic suggestions played through earphones during general anaesthesia could provide a safe, feasible, inexpensive, and non-drug technique to reduce postoperative pain and opioid use, with the potential for more general use. Based on the finding of intraoperative perception by a considerable number of patients, surgeons and anaesthetists should be careful about background noise and conversations during surgery.

Trial registration

German Clinical Trial Register DRKS00013800.

给我留言

您必须 [ 登录 ] 才能发表留言!

×
腾讯微博