减轻局麻手术患者术中疼痛感的最佳证据总结

Summary of the best evidence for alleviating intraoperative pain in patients undergoing local anesthesia

目的检索、评价和整合减轻局麻手术患者术中疼痛感的最佳证据,为临床制订局麻手术患者术中疼痛控制方案提供依据。方法根据PICO模式构建循证问题,系统检索BMJ Best Practice、UpToDate、美国指南网、英国国立健康与临床优化研究所、苏格兰校际指南网、澳大利亚JBI循证卫生保健中心、Cochrane Library、MedlinePlus、PubMed、CINAHL、医脉通、CNKI、万方数据库关于减轻局麻手术患者术中疼痛感方面的指南、专家共识、证据总结、系统评价等证据。检索时间为建库至2020年3月30日。由2名具有循证护理知识的研究人员独立对文献进行质量评价和证据级别评定。结果共纳入文献7篇,包括指南1篇、临床决策1篇、系统评价5篇,从术前评估、疼痛识别、术中疼痛干预措施、手术疼痛评定、健康教育5个方面汇总16条最佳证据。结论本研究总结了目前关于减轻局麻手术患者术中疼痛感的最佳证据,为相关科室局麻术中疼痛控制方案的选择提供一定的循证依据。医护人员应结合医院特点和临床背景,有针对性地选择证据,以减轻局麻手术患者术中的疼痛感,提升患者手术体验。

Objective To search,evaluate and integrate the best evidence for alleviating intraoperative pain in patients undergoing local anesthesia,so as to provide a basis for formulating intraoperative pain control plan for patients undergoing local anesthesia.Methods Evidence-based questions were built based on the PICO model.BMJ Best Practice,UpToDate,US Guidelines,National Institute for Health and Clinical Excellence,Scottish Intercollegiate Guidelines Network,Joanna Briggs Institute Evidence-based Health Care Center,Cochrane Library,MedlinePlus,PubMed,CINAHL,Medlive,CNKI and Wanfang Database were searched for guidelines,expert consensus,evidence summary,systematic review and other evidence on alleviating intraoperative pain in patients undergoing local anesthesia.The search time was from the establishment of the database to March 30,2020.Two researchers with evidence-based nursing knowledge independently evaluated the quality of the literature and the level of evidence.Results A total of 7 articles were included,including 1 guideline,1 clinical decision and 5 systematic reviews.The 16 best evidences were summarized from 5 aspects,such as preoperative evaluation,pain recognition,intraoperative pain intervention measures,surgical pain evaluation and health education.Conclusions This study summarizes the current best evidence for reducing the pain during local anesthesia in patients undergoing local anesthesia and provides evidence-based evidence for the selection of intraoperative pain control programs for local anesthesia in related departments.