背景：疼痛是病患手術前最害怕的問題，也是手術後遇到的第一個難題。而恢復室是手術病患麻醉後的第一個留置單位，因此疼痛問題的處置顯得格外重要。鴉片類止痛劑使用是手術後施行疼痛管理的重要步驟，恢復室定期評估病患自訴0-10比分的疼痛測量指數情形，適當的給予止痛劑，可使病人免於手術後的初期疼痛。本研究目的主要是探討恢復室婦科手術病患止痛劑需求的疼痛指數標準相關影響因素。
方法：研究對象為婦科手術病患，於恢復室留置期間施行定時疼痛第五生命徵象疼痛評估進行資料分析，資料包括病患基本資料、恢復室留置期間病患自訴的疼痛分數、手術方式、預期疼痛程度、手術全身麻醉中暨恢復室止痛劑給予劑量；藉由利用邏輯斯迴歸統計分析方法，探討出主要影響因素，進而尋找關鍵預測因數。
結果：研究結果發現，恢復室給藥前疼痛評估指數與病患手術後身上引流管留置數量能顯著影響恢復室止痛劑之需求，其解釋變異量高達68.8％；以疼痛指數之邏輯斯迴歸模型所對應之ROC曲線圖（Receiver Operator Characteristic Curve）上，顯示當疼痛指數達3時，應為恢復室婦科手術病患疼痛需求介入之最佳指標。
結論：本研究結果疼痛指數到達3分為止痛劑給予的閾值，提供恢復室醫護人員進行疼痛管理時之參考，以促進恢復室留置期間之婦科手術病患，手術後疼痛處置的安全及舒適，增進照護品質及顧客滿意度。 Background. Postoperative pain is one of the most significant psychosomatic stresses of the patients before and after undertaking surgical intervention. Therefore, management of postoperative pain has been an important clinical issue in the post anesthesia care units (PACU). Among the available pain medicine, opioids are the most commonly prescribed analgesic for postoperative pain control. The present study aimed to identify the coexisting factors that affected the requirement of opioids in patients receiving gynecological surgery.
Methods. All the patients receiving gynecological surgery were recruited after admitted to the PACU. Patient demographic data, type of operation, predicted and patient’s self-report pain scales, and the total amount of pain medicine administered throughout the course were recorded. A pain scale was utilized to rate the pain intensity on the scale of 0 (no pain) to 10 (the worst pain imaginable). The relationships between opioid demand and these parameters were determined by multivariate analysis.
Results. Since opioid was prescribed according to the pain scale, the self-report pain scale was highly correlated with the dose of opioid administered. Numbers of drainage tubes indwelled were also significant independent predictors for postoperative requirement of opioids (interpretation variation of 68.8%). Using the standard receiver operating characteristic (ROC) curve, pain scale of 3 was determined as the threshold value for initiating pain management with a predicted probability of 47.6%.
Conclusion. Our results provide fundamental rationale for prescribing opioids in the management of postoperative pain following gynecological surgery. Application of optimal pain medicine at the appropriate time point may improve quality of postoperative care and patient contentment in the PACU.
