在接受结肠直肠手术的患者中,多种模式的止痛药捆绑和术后的阿片类药物使用
Claes Gedda1,2, Jonas Nygren1,2, Anna Garpenbeck1
1Department of Surgery and Anesthesiology, Ersta Hospital, Stockholm, Sweden.
JAMA network open
|September 6, 2023
概括
实施包括个性化阿片类药物治疗方案和 gabapentin 在结直肠外科手术患者中的术后阿片类药物消耗显著降低的护理包. 这种方法为阿片类药物节约性疼痛管理提供了一个有希望的策略.
科学领域:
- 手术 手术 手术
- 麻醉学 麻醉学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在手术中减少阿片类药物的使用对于减轻胃肠道问题,疲劳和依赖等不良影响至关重要.
- 大型腹部手术往往需要显著的术后疼痛管理,历史上严重依赖阿片类药物.
研究的目的:
- 评估包括三个阿片类药物节约干预措施的护理包对主要腹部手术患者手术后阿片类药物消费的影响.
- 调查每个干预措施在护理包中的个人贡献.
主要方法:
- 追溯队列研究涉及842名患者,他们在2016年至2019年期间接受了重大结直肠手术.
- 实施包括个性化阿片类药物治疗方案,常规 gabapentinoids 和克洛尼丁作为救援止痛药在内的护理包.
- 在外科手术前期 (手术前一天和术后的前5天) 使用吗啡毫克相当量 (MME) 的医院内阿片类药物 (静脉注射和口服) 的分析.
主要成果:
- 中位数阿片类药物使用量从2016年的75个MME显著下降到2019年的22个MME (P < .001).
- 接受45个MME或更少患者的比例从35%增加到66% (P < .001).
- 多变量分析发现,个性化阿片类药物策略 (β = -11.6) 和定期使用 gabapentin (β = -39.1) 与减少阿片类药物消费有显著的关联,而克隆尼丁使用与摄入量增加有关 (β = 11.6).
结论:
- 一个包含个性化阿片类药物治疗方案和常规 gabapentin 的护理包在结直肠手术中显著降低了术后阿片类药物消耗.
- 个性化阿片类药物策略和常规 gabapentin 是开发多式,无阿片类药物的术后止痛的关键组成部分.
- 需要进一步的研究来验证这些发现,并优化阿片类药物节约方案.
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