减少慢性阿片类药物使用:乳房切除术后增强康复的长期影响 乳房切除术协议
Kristen Jogerst1,2, Nikita Gupta3, Heidi E Kosiorek4
1Department of General Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ.
Annals of surgery
|May 17, 2024
概括
手术后增强恢复 (ERAS) 协议显著减少了乳腺切除患者的长期阿片类药物使用,而没有增加镇静剂的使用. 这一发现支持ERAS的实施,以改善术后疼痛管理和减少慢性药物依赖.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 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:
- 已知手术后增强恢复 (ERAS) 协议可缩短住院时间,减少乳房切除术后的急性疼痛和阿片类药物需求.
- 乳腺切除术后90天以上的慢性阿片类药物和镇静剂使用ERAS协议的长期影响仍然不太清楚.
- 调查这些长期结果对于全面的患者康复和管理至关重要.
研究的目的:
- 评估ERAS协议对长期 (超过90天) 的阿片类药物和镇静剂在接受乳房切除术或不进行植入式乳房重建 (IBBR) 的患者的使用的影响.
- 在这个患者群体中确定与慢性阿片类药物和镇静剂使用增加相关的因素.
主要方法:
- 在2013年1月至2019年12月期间,对756名接受了带有或没有IBBR的乳腺切除术的患者进行了回顾性审查.
- 患者被分为ERAS前 (2017年2月之前) 和ERAS (2017年2月之后) 的两组.
- 使用后勤回归分析来比较基线特征,并预测慢性阿片类药物和镇静剂使用的因素.
主要成果:
- 在ERAS实施后,慢性阿片类药物使用在未使用阿片类药物 (40%至30%) 和阿片类药物耐受性患者 (58%至37%) 中均下降.
- 没有观察到慢性镇静剂使用的显著增加.
- 与慢性阿片类药物使用增加相关的因素包括双边手术,两阶段重建,更高的PACU疼痛得分和更高的阿片类药物毫克相当量.
结论:
- ERAS协议与长期慢性阿片类药物使用的显著减少有关,在乳腺切除术后有或没有IBBR.
- 这些协议并没有导致慢性镇静剂使用的同时增加.
- 实施ERAS似乎是缓解乳腺癌手术后长期阿片类药物依赖的安全有效策略.
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