| Background:More than 320 million people undergo surgery every year worldwide.It is worth noting that the incidence of postoperative pain is as high as 50-75% and the incidence of postoperative pain after orthopedic surgery is increasingly high.The intensity and duration of that pain after orthopedic surgery are high,and 48% to 59% of patients experience moderate to severe pain after surgery.Excessive pain not only causes unbearable psychological experiences for patients,but also seriously affects multiple physiological systems of postoperative patients which delays their recovery,and even leads to more serious postoperative complications.The Multidisciplinary Team(MDT)model for improving perioperative pain management has been widely recommended by domestic and international guidelines and expert consensus.Clinical pharmacists are imperative members of the Multidisciplinary Pain Management Organization(PMDT)and play an active role in medication education,medication reconciliation,medication therapy development,efficacy monitoring,and follow-up.However,the practice of integrating clinical pharmacists in perioperative pain management still needs to be developed,and the lack of a standardized pharmaceutical practice model for perioperative pain management is one of the vital factors affecting development.Objective:To construct a practical model for clinical pharmacists to participate in multidisciplinary pain management during orthopedic perioperative periods,which is becoming an achievable and replicable pain pharmacist practice model.This model can not only fill the gap in the role of pharmacists in most perioperative PMDT at present,but also promote the transformation and development of pharmaceutical services.Methods:Our study used a historical controlled method,the control group consisted of patients who underwent surgery from July 2019 to June 2020.They received routine treatment and care from our orthopedic department without clinical pharmacist’s intervention(pharmacists provided routine prescription review services).The intervention group included patients who underwent surgery from July 2020 to June2021 and underwent MDT pain management.Pain pharmaceutical services included promoting homogenized pain assessment,developing clinical pathways for analgesic drug use,conducting pharmaceutical education and training,and providing integrated pharmaceutical monitoring for patients.Pharmacists collected general information about patients and pain assessment upon admission,using the Numerical Rating Scale(NRS)to evaluate and collect the patient’s resting and active pain scores immediately after surgery(when the patient is awake)and coring the patient’s resting and active pain at 24,48 and 72 hours.We also recorded the patient’s break-out pain,postoperative analgesic drug use(except during the operation),multimodal drug analgesia,adverse drug reactions(ADRs)and length of hospital stay,Through comparative analysis of these indicators,the role and value of clinical pharmacy services for orthopedic perioperative pain were evaluated.Results:A total of 320 orthopedic surgery patients were included in this study,of which158 were included in the control group and 162 in the intervention group.There was no significant difference between the two groups in terms of basic characteristics such as gender,age,and surgical site,as well as pain site on admission,nature of pain,resting and active pain scores,impact on daily life and work,impact on sleep and break-out pain(P > 0.05).Clinical pharmacists had constructed a pain pharmacy practice model rooted in the MDT framework in the intervention group,and carried out a series of pharmaceutical services based on this,which has to some extent improved the quality of pain management:(1)Postoperative pain control: There was a significant difference(P < 0.05)in the resting pain score between the intervention group and the control group 24 hours after surgery,while there was a significant difference(P < 0.05)in the active pain score between the intervention group and the control group at 24 hours,48 hours,and72 hours after surgery.Among patients with expected moderate and severe postoperative pain(82.5%),there was a significant difference(P < 0.05)in pain scores between the intervention group and the control group 24 hours after surgery.(2)Break-out pain situation: 34 patients in the intervention group experienced break-out pain,accounting for 21.52 %,a total of 57 times.37 patients in the control group experienced break-out pain,accounting for 22.84%,a total of 49 times.There was no statistical difference(P > 0.05)in the control of break-out pain(number and frequency of occurrences)between the two groups.(3)Reasonability evaluation of pain medication use: There was a significant difference(P < 0.05)in the rational use of pain medication between the intervention group and the control group.The rationality of medication use in the intervention group was significantly higher than that in the control group.Among them,NSAIDs were the drug varieties with the most unreasonable medication problems.(4)Multimodal drug analgesia: Patients with expected moderate to severe postoperative pain were significantly different in the combination of analgesic drugs between the two groups(P < 0.05),48(36.9%)patients in the control group used multimodal drug analgesia and 71(53.0%)patients in the intervention group received multimodal drug analgesia.(5)Adverse reactions to analgesics: Patients in the intervention group and the control group only experienced transient ADRs,both of which were classified as adverse reaction general terminology standards(CTCAE)1-2 levels,with no significant difference in incidence(P > 0.05).(6)Hospitalization days: The hospitalization days in the intervention group were shortened by 2.32 days compared to the control group(P < 0.05);Among patients with expected mild and moderate pain(43.1 %),there was no significant difference in hospital stay between the intervention group and the control group(P > 0.05),while among patients with expected severe pain(56.9%),the intervention group shortened hospital stay by 3.32 days compared to the control group(P < 0.05).Conclusion:Our research preliminarily constructed a practical model for clinical pharmacists to participate in multidisciplinary pain management during the orthopedic perioperative period.The pharmacist’s work varied from promoting homogeneous pain assessment,developing clinical pathways for graded use of analgesic drugs,conducting pharmaceutical education and training,and providing integrated pharmaceutical monitoring for patients.The results indicated that pain pharmaceutical services are inclined to improve postoperative pain control rate,rational use of analgesics,and the proportion of multimodal drug analgesic plans,effectively reduce hospitalization days,and optimize the quality of perioperative pain management.This fully reflected the role and value of clinical pharmacist work,providing guidelines for future work in this area and enriching the content of pharmaceutical services. |
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