在澳大利亚的环境中,骨科手术前阿片类药物使用的流行率和预测因素:一个多中心,横截面,观察性研究
Shania Liu1,2, Jennifer A Stevens3,4, Ashleigh E Collins3
1Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Anaesthesia and intensive care
|June 21, 2023
概括
在骨科手术前进行手术前使用阿片类药物很常见,影响超过三分之一的患者. 内部区域医院的病率较高,突出显示了阿片类止痛药使用的地理差异.
科学领域:
- 整形外科手术 整形外科手术
- 疼痛管理 疼痛管理
- 公共卫生 公共卫生
背景情况:
- 在骨科手术之前,阿片类止痛药经常被处方给患者.
- 手术前使用阿片类药物与术后疼痛增加,手术结果较差以及医疗保健费用增加有关.
- 了解手术前阿片类药物使用的流行率对于优化患者护理和资源配置至关重要.
研究的目的:
- 在接受选择性骨科手术的患者中确定术前阿片类止痛药的使用率.
- 根据医院环境调查阿片类药物使用的变化,特别是比较澳大利亚新南威尔士州的大都市,区域和农村地区.
主要方法:
- 在2017年4月至2019年11月期间进行了一项横截面的观察性研究.
- 在新南威尔士州的五家医院 (大都市,区域,农村,私营,公共) 收集了430名患者的数据.
- 手术前的数据包括患者人口统计,疼痛评分和止痛药的使用,这些数据是在入院前的诊所访问期间收集的.
主要成果:
- 总体而言,37.7%的患者 (162/430) 报告在手术前使用阿片类止痛药.
- 在手术前使用阿片类药物的患病率因地点而异,从大都市医院的20.6%到内区域医院的48.8%.
- 后勤回归确定了一个内部区域设置作为术前阿片类药物使用的显著预测因素 (调整后的几率比率2.6).
结论:
- 在选择性骨科手术之前使用阿片类药物是一个广泛的问题.
- 地理位置,特别是区域内设置,与手术前阿片类药物使用率较高有关.
- 这些发现强调了针对性干预和进一步研究外科手术期间疼痛管理中的区域差异的需要.
相关概念视频
Opioid Analgesics: Synthetic and Semisynthetic Opioids
348
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
348
Analgesia and Pain Management
668
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
668
Opioid Analgesics: Morphine and Other Natural Cogeners
302
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
302
Drugs Affecting GI Tract Motility: Opioids as Antidiarrheal Agents
249
Diarrhea, a condition marked by frequent loose or watery bowel movements, can be triggered by multiple factors such as viral or bacterial infections, food intolerances, anxiety, medications, and digestive disorders. Symptoms may include abdominal pain, bloating, nausea, and cramping. Severe or prolonged diarrhea can lead to complications like electrolyte imbalances, malnutrition, and dehydration if left untreated.
Opioids, widely used antidiarrheal agents, mitigate diarrhea by slowing down...
Opioids, widely used antidiarrheal agents, mitigate diarrhea by slowing down...
249
Opioid Receptors: Overview
1.1K
Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
1.1K
Aneurysm IV: Nursing Management
11
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
11


