A systematic review of guidelines on the management of patient-controlled analgesia in adult patients with postoperative acute pain

doi:10.3761/j.issn.0254-1769.2021.12.018

Abstract

Abstract:

Objective The quality evaluation and content analysis of the existing guidelines concerning management of patient-controlled analgesia（PCA） in adult patients with postoperative acute pain were conducted to provide recommendations for its management. Methods Evidence-based guidelines involving recommendations of PCA management with postoperative pain were searched in guidelines networks,websites of pain management and anaesthesiology,and databases from inception to April 2021. AGREE Ⅱ was used to appraise the quality of guidelines;the recommendations related to PCA management of postoperative pain were synthesized. Results A total of 783 pieces of the literature were initially detected,and finally 9 evidence-based guidelines were included,among which 3 were rated as A and 6 were rated as B,with the relatively high quality. 23 recommendations were extracted and summarized from 9 guidelines,involving 6 domains,namely organization management,education and training,analgesia mode selection,patient education,preoperative assessment,and postoperative monitoring and assessment. Conclusion The guidelines are of high quality in total,providing recommendations on PCA management of postoperative pain;however,the independence and applicability of the guidelines need to be improved. The recommendations of PCA management are scattered in different guidelines and lack targeted specific PCA management strategies.

Key words: Postoperative Pain, Patient-Controlled Analgesia, Guideline, Quality Appraisal, Evidence-Based Nursing

摘要：

目的对术后急性疼痛患者自控镇痛（patient controlled analgesia,PCA）管理相关指南进行质量评价和内容分析,为制订术后急性疼痛PCA管理规范提供依据。方法计算机检索国内外指南网、相关专业学会网站及数据库,检索术后疼痛PCA管理相关循证指南,检索时限为建库至2021年4月。应用临床指南研究与评价工具Ⅱ（appraisal of guidelines for research and evaluation instrument Ⅱ,AGREE Ⅱ）对指南进行质量评价,汇总术后疼痛PCA管理的推荐意见。结果初检到783篇文献,最终纳入9部指南,3部指南的总体质量评价为A级,6部为B级,整体质量较高。从9部指南中提取23条术后疼痛PCA管理相关推荐意见,涉及组织管理、教育与培训、镇痛模式的选择、患者教育、术前评估、术后监测与评估6个方面。结论纳入的指南质量整体较高,为术后急性疼痛PCA规范管理提供了依据,但在独立性、应用性领域有待提高;关于术后疼痛PCA管理的推荐意见散在分布,缺乏具体针对性的管理策略。

关键词: 术后疼痛, 患者自控镇痛, 指南, 质量评价, 循证护理学

ZHANG Junfeng, CAI Yingying, ZHENG Kexin, CHEN Miaoting, LIU Xingling, WU Yanni. A systematic review of guidelines on the management of patient-controlled analgesia in adult patients with postoperative acute pain[J]. Chinese Journal of Nursing, 2021, 56(12): 1868-1875.

张俊峰, 蔡莹莹, 郑可欣, 陈妙婷, 刘兴玲, 吴艳妮. 术后急性疼痛患者自控镇痛管理相关指南的系统评价[J]. 中华护理杂志, 2021, 56(12): 1868-1875.

Figures/Tables 5

Figure 1 Guidelines screening process and results

Tab.1 Characteristics of included guidelines（n=9）

Tab.2 Consistency test results of intraclass correlation coefficient（n=9）

Tab.3 AGREE Ⅱ scores in various domains and overall quality appraisal（n=9）

Tab.4 Summary of recommendations on PCA management for patients with postoperative acute pain

References 34

[1]	Wahila R, Odimba E, Ngoma C. Developing a pain assessment tool for patients after major abdominal surgery[J]. Br J Nurs, 2018, 27(9):503-507. DOI PMID
[2]	Mitra S, Carlyle D, Kodumudi G, et al. New advances in acute postoperative pain management[J]. Curr Pain Headache Rep, 2018, 22(5):1-11. DOI URL
[3]	章梅云, 陈国英, 冯芳, 等. 2321例住院患者疼痛控制及管理现状的调查与分析[J]. 中国疼痛医学杂志, 2013, 19(12):762-764.
	Zhang MY, Chen GY, Feng F, et al. Investigation and analysis of the current status of pain control and management in 2321 inpatients[J]. Chin J Pain Med, 2013, 19(12):762-764.
[4]	Ljungqvist O. ERAS-enhanced recovery after surgery:moving evidence-based perioperative care to practice[J]. J Parenter Ente-ral Nutr, 2014, 38(5):559-566.
[5]	Schug SA, Palmer GM, Scott DA, et al. Acute pain management:scientific evidence,fourth edition,2015[J]. Med J Aust, 2016, 204(8):315-317. DOI URL
[6]	Yankova Z. Patients’ knowledge of patient controlled analgesia(PCA) and their experience of postoperative pain relief:a review of the impact of structured preoperative education[J]. J Ad Perioper Care, 2008, 3(3):91-99.
[7]	何群辉, 曲华, 于鲁欣, 等. 国内外术后患者自控镇痛护理管理现状与思考[J]. 航空航天医学杂志, 2017, 28(10):1270-1272.
	He QH, Qu H, Yu LX, et al. Current situation and thinking on nursing management of postoperative patient-controlled analgesia in domestic and abroad[J]. J Aerosp Med, 2017, 28(10):1270-1272.
[8]	Brouwers MC, Kerkvliet K, Spithoff K. The AGREE reporting checklist:a tool to improve reporting of clinical practice guidelines[J]. BMJ, 2016, 352:i1152.
[9]	American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting:an updated report by the American Society of Anesthesiologists task force on acute pain management[J]. Anesthesiol, 2012, 116(2):248-273. DOI URL
[10]	Korean Knee Society. Guidelines for the management of postoperative pain after total knee arthroplasty[J]. Knee Surg Relat Res, 2012, 24(4):201-207. DOI URL
[11]	Australian and New Zealand College of Anaesthetists. Guidelines on acute pain management[EB/OL].(2013-04-01)[2021-08-01]. https://www.anzca.edu.au/24889eeb-3e96-4887-8c18-53c-6650cdf6d.
[12]	Registered Nurses’ Association of Ontario. Assessment and ma-nagement of pain third edition[EB/OL].(2016-11-30)[2021-08-01]. https://rnao.ca/bpg/guidelines/assessment-and-management-pain.
[13]	Espitalier F, Testelin S, Blanchard D, et al. Management of so-matic pain induced by treatment of head and neck cancer:postoperative pain. Guidelines of the French Oto-Rhino-Laryn-gology - Head and Neck Surgery Society(SFORL)[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2014, 131(4):249-252. DOI PMID
[14]	Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain:a clinical practice guideline from the American Pain Society,the American Society of Regional Anesthesia and Pain Medicine,and the American Society of Anesthesiologists’ Committee on Regional Anesthesia,Executive Committee,and Administrative Council[J]. J Pain, 2016, 17(2):131-157. DOI URL
[15]	Cornelius R, Herr KA, Gordon DB, et al. Evidence-based practice guideline:acute pain management in older adults[J]. J Gerontol Nurs, 2017, 43(2):18-27. DOI PMID
[16]	Aubrun F, Nouette-Gaulain K, Fletcher D, et al. Revision of expert panel’s guidelines on postoperative pain management[J]. Anaesth Crit Care Pain Med, 2019, 38(4):405-411. DOI URL
[17]	National institute of clinical evidence. Perioperative care in adults[EB/OL].(2020-08-19)[2021-08-01]. https://www.nice.org.uk/guidance/ng180.
[18]	Sox HC. Conflict of interest in practice guidelines panels[J]. JAMA, 2017, 317(17):1739-1740. DOI URL
[19]	Schünemann HJ, Al-Ansary LA, Forland F, et al. Guidelines international network:principles for disclosure of interests and management of conflicts in guidelines[J]. Ann Intern Med, 2015, 163(7):548-553. DOI PMID
[20]	Gundersen L. The effect of clinical practice guidelines on variations in care[J]. Ann Intern Med, 2000, 133(4):317-318. PMID
[21]	程湘玮, 王培红, 屠凤鸣, 等. 妊娠期糖尿病产妇分娩的新生儿血糖管理审查指标的制订及障碍因素分析[J]. 中华护理杂志, 2020, 55(10):1497-1502.
	Cheng XW, Wang PH, Tu FM, et al. Establishment and obstacle analysis of evidence-based nursing indexes of blood glucose management in neonates delivered by mothers with gestational diabetes[J]. Chin J Nurs, 2020, 55(10):1497-1502.
[22]	丁泓帆, 杨楠, 邓围, 等. WHO指南制定的基本原则和方法[J]. 中国循证医学杂志, 2016, 16(4):471-477.
	Ding HF, Yang N, Deng W, et al. Principles and methods of WHO guidelines development[J]. Chin J Evid Based Med, 2016, 16(4):471-477.
[23]	徐建国. 成人手术后疼痛处理专家共识[J]. 临床麻醉学杂志, 2017, 33(9):911-917.
	Xu JG. Expert consensus on pain management after adult surgery[J]. J Clin Anesthesiol, 2017, 33(9):911-917.
[24]	王惠珍, 王英丽, 张圣洁, 等. 不同医务人员对PCA泵使用方法认知度的调查研究[J]. 中国医学装备, 2017, 14(8):39-42.
	Wang HZ, Wang YL, Zhang SJ, et al. Investigation on the awareness of different medical personnel on the use of PCA pump[J]. China Med Equip, 2017, 14(8):39-42.
[25]	卢苇. 福建省三级甲等医院临床护士疼痛知识与态度调查分析[J]. 中国护理管理, 2014, 14(11):1137-1139.
	Lu W. Investigation of the knowledge and attitude regarding pain in clinical nurses in tertiary a hospitals in Fujian province[J]. Chin Nurs Manag, 2014, 14(11):1137-1139.
[26]	张俊峰, 蔡莹莹, 曾文. 广东省40家三级医院护士疼痛管理知识与态度现况及其影响因素分析[J]. 岭南急诊医学杂志, 2020, 25(5):541-544.
	Zhang JF, Cai YY, Zeng W. Survey and analysis on the knowledge and attitude of pain management among nurses in 40 tertiary hospitals in Guangdong province[J]. Lingnan J Emerg Med, 2020, 25(5):541-544.
[27]	王婷, 花芸, 涂红星, 等. 华中地区儿科护士疼痛管理知识及态度的现状调查[J]. 中华护理杂志, 2016, 51(6):681-685.
	Wang T, Hua Y, Tu HX, et al. A multicenter study on pediatric nurses’ knowledge and attitudes regarding pain management in central China[J]. Chin J Nurs, 2016, 51(6):681-685.
[28]	Macintyre PE. Safety and efficacy of patient-controlled analgesia[J]. Br J Anaesth, 2001, 87(1):36-46. DOI URL
[29]	丁红, 邓宇, 林玉玲, 等. 广东省三级医院麻醉科护士工作岗位现状调查[J]. 护理学杂志, 2020, 35(4):57-59.
	Ding H, Deng Y, Lin YL, et al. Investigation on anaesthetic nurses’ job duties in 3 A hospitals in Guangdong province[J]. J Nurs Sci, 2020, 35(4):57-59.
[30]	韩文军, 邓小明, 赵继军. 手术后患者自控镇痛的管理策略[J]. 国际麻醉学与复苏杂志, 2015, 36(1):73-77.
	Han WJ, Deng XM, Zhao JJ. Management strategy of patient-controlled analgesia after surgery[J]. Int J Anesthesiol Resusc, 2015, 36(1):73-77.
[31]	林晓蕾, 黄凤, 吴玉珍, 等. 自控镇痛泵针对性护理在晚期胃癌患者中的应用效果[J]. 护理实践与研究, 2020, 17(16):142-144.
	Lin XL, Huang F, Wu YZ, et al. Application effect of the targeted nursing of self-controlled analgesia pump on patients with advanced gastric cancer[J]. Nurs Pract Res, 2020, 17(16):142-144.
[32]	彭博. 自控镇痛泵访视在全麻患者腹部手术后疼痛控制中的应用效果[J]. 临床医学研究与实践, 2020, 5(27):182-184.
	Peng B. Application effect of patient controlled analgesia visit on pain control of patients after abdominal surgery under general anesthesia[J]. Clin Res Pract, 2020, 5(27):182-184.
[33]	潘巧, 李漓, 王灵晓. 成人术后急性疼痛管理指南中疼痛评估内容的质量评价与分析[J]. 现代临床护理, 2020, 19(4):53-59.
	Pan Q, Li L, Wang LX. Quality appraisal and content analysis of pain assessment in guidelines for postoperative pain management in adults[J]. Mod Clin Nurs, 2020, 19(4):53-59.
[34]	郭建丽, 朱婧, 杨峻岭, 等. 无线远程监控镇痛泵在腹腔镜肠癌根治术后患者自控静脉镇痛中的效果[J]. 中国临床研究, 2020, 33(5):665-668.
	Guo JL, Zhu J, Yang JL, et al. Effect of wireless remote monitoring analgesia pump in patient-controlled intravenous analgesia after laparoscopic colorectal cancer radical operation[J]. Chin J Clin Res, 2020, 33(5):665-668.