术内阿片类药物给药与术后疼痛和阿片类药物使用的关联
Laura A Santa Cruz Mercado1,2,3, Ran Liu1,2, Kishore M Bharadwaj1,2
1Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston.
JAMA surgery
|June 14, 2023
概括
优化手术内阿片类药物管理,特别是芬太尼和水墨,可以减少术后疼痛和长期阿片类药物使用. 减少手术内阿片类药物可能无意中增加术后疼痛和消耗,影响长期结果.
科学领域:
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
- 药理学 药理学是指药理学的学科.
背景情况:
- 治疗术后疼痛的阿片类药物有助于阿片类药物危机,慢性使用影响了许多患者.
- 减少手术内阿片类药物使用可能会对术后疼痛和阿片类药物需求产生负面影响.
- 在手术期间使用阿片类药物和以后的阿片类药物需求之间的关系尚未得到充分理解.
研究的目的:
- 为了研究手术内阿片类药物和术后疼痛之间的关联.
- 描述手术内阿片类药物使用对后续阿片类药物需求的影响.
- 评估手术内阿片类药物对疼痛和依赖的长期影响.
主要方法:
- 对于接受全身麻醉非心脏手术的成年患者进行了回顾性队列研究.
- 分析了来自四级护理学术医疗中心的电子健康记录.
- 药理动力学/药理动力学模型估计了手术期间的芬太尼和摩暴露;统计模型评估了结果.
主要成果:
- 增加的手术内芬太尼和水墨的含量与较低的最大PACU疼痛评分有关.
- 较高的手术内阿片类药物剂量与减少的PACU阿片类药物管理相关.
- 增加芬太尼的使用与更少的不受控制的疼痛,更少的慢性疼痛诊断和长期阿片类药物处方的减少有关.
结论:
- 减少手术内阿片类药物的使用可能会无意中增加术后疼痛和阿片类药物的消耗.
- 优化手术内阿片类药物管理可能会导致更好的长期疼痛和阿片类药物使用结果.
- 这些发现挑战了当前在手术期间减少阿片类药物使用的趋势.
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