| Objective: This paper is to investigate the effect of postoperative pain management based on Movement-evoked pain assessment on the pain management quality in gynecologic oncology patients which undergo laparotomy and laparoscopic surgery.Methods: Select 180 cases of patients who is elective laparotomy and laparoscopic surgery in our hospital gynecological as the research object,90 cases of postoperative patients from June 1st 2017 to Jul 31 st who haven’t received the postoperative pain management based on Movement-evoked paint assessment are served as control group and 90 cases of patients from September 1st 2017 to October 31 st who have received the postoperative pain management based on Movement-evoked paint assessment are served as experimental group.Patients in the control group were only used Numeric Pain Intensity Scale(NRS)to assess the pain at least once every 6 hours within 24 hours after operation,and the corresponding analgesic measures were given according to the assessment results.The experimental group patients were used both NRS and Functional Activity Score(FAS)to evaluated the pain within 24 hours after surgery every 6 hours and analgesic measures were given based on the assessment.The investigators themselves investigated the expected degree of pain in preoperatively and investigated the intensity of Rest pain and Dynamic pain,FAS score,pain control within 24 hours after operation,the indicators of postoperative pain management quality,the first time of ambulation and the recovery of intestinal function in two groups.Results: 1.The comparison of baseline results showed that there was no significant difference between the two groups in the age,marital status,educational level,occupational status,medical payment,family monthly income,disease classification and operation type(P> 0.05).2.The comparison of Rest pain and Movement-evoked pain that the patient’ self-rated: At 24 hours after operation,the self-rated Resting pain intensity of the control group was 2.31 ± 1.097,the experimental group was 2.01 ± 0.838,there was no statistically significant(t = 1.984,P = 0.167> 0.05).The control group patients with self-rated Movementevoked pain intensity was 6.14 ± 1.214,the experimental group was 5.19 ± 0.932,the difference was significant(t=5.738,P=0.000<0.05).3.The comparison of FAS rating scale: In the experimental group,the 24 h FAS score of grade Ⅲ and grade Ⅳ was significantly lower than that of the control group(x~2=27.576,P<0.05).4.The comparison of the quality of pain controlled: At 24 hours after operation,intensity of the worst pain in control group was 6.36 ± 0.940,the lightest pain was 1.96 ± 0.870 and the average pain was 3.95 ± 0.930,while,the experimental group were 5.35 ± 0.735,1.75 ± 0.688 and 3.05 ± 0.800 respectively,and there was no significant difference in the lightest postoperative pain between groups(t=1.752,P=0.082>0.05),while the worst postoperative pain and average pain were significantly lower in the experimental group than in the control group(t=7.742,P=0.000<0.05;t=6.785,P=0.000<0.05).In the frequency of moderate-to-severe postoperative pain,the frequency of “always”,“more frequently”,“frequently”,“occasionally” and “never” in the control group was 8.3%,29.8%,16.7%,41.7%,and 3.6%,respectively.The corresponding groups were 1.2%,12.9%,16.5%,57.6%,and 11.8%,respectively,and the results were significantly different(x~2=16.042,P=0.003>0.05).Compared the effects of postoperative pain on patients’ functional activity and sleep between groups,showed that the experimental groups were significantly better than the control group at the functional activities and sleeping(t=5.294,and 4.161,P <0.05).5.The satisfaction of the treatment of pain: Before surgery,we counted the degree of postoperative pain expected by the patient,severity pain was 86.98% and painless was 13.02% in the two groups.There was no significant difference(x~2=0.183,P=0.669>0.05).the Satisfaction with postoperative pain control 、doctors and nurses in treatment of pain was not statistically significant either(x~2=3.499,P=0.321>0.05;x~2=4.571,P=0.102>0.05;x~2=2.918,P=0.233>0.05).Besides,there was no statistically significant difference between the two groups in the assessment of the pain-related information provided(x~2=0.746,P=0.689>0.05).However,in the "Very Satisfied" option for the pain controlled,the control group was 69.0% and the experimental group was 78.8%.On the "Very Satisfied" option for the method which doctors and nurses deal with the pain,the control group were 72.6% and 73.8%,while the experimental group were 84.7% and 83.5%,the experimental group were significantly higher than the control group.6.The first time of ambulation and the recovery of intestinal function: postoperative ambulation time,the first time of the anal exhaust and defecation,the experimental group was significantly earlier than those in the control group(F=18.652,P=0.000<0.05;F=10.832,P=0.001<0.05 and F=5.022,P=0.026<0.05).Conclusion:1.The practice of postoperative pain management based on Movement-evoked pain assessment could help to guide the staff to evaluate the patients’ postoperative pain comprehensively and take effective analgesia measures.Reduce postoperative pain and improve postoperative pain management quality.2.The practice of postoperative pain management based on Movement-evoked pain assessment could promote patients to carry out functional activities early,can promote early ambulation and promote the recovery of intestinal function also.3.The practice of postoperative pain management based on Movement-evoked pain assessment also improve the quality of postoperative pain management. |
