在高风险的外科退伍军人中,过渡性疼痛服务的利用和阿片类药物结果:一个队列研究
Seshadri C Mudumbai1,2, Ji-Qing Chen3,4, Oluwatobi O Hunter3
1Anesthesiology, Perioperative and Pain Medicine Service, VA Palo Alto Health Care System, Palo Alto, CA, USA mudumbai@stanford.edu.
Regional anesthesia and pain medicine
|December 24, 2025
概括
疼痛灾难化和物质使用史预测了更高的阿片类药物使用和过渡性疼痛服务 (TPS) 的利用. 心理社会查对于管理风险患者的手术后疼痛有价值.
科学领域:
- 疼痛管理 疼痛管理
- 精神病学是一个精神病学.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 术后期对患有精神病并发症或物质使用障碍的患者构成风险,增加了对长期阿片类药物使用的易感性.
- 过渡性疼痛服务 (TPSs) 旨在管理疼痛,缓解阿片类药物,并支持恢复,但驱动高利用率的因素仍然不清楚.
研究的目的:
- 确定过渡性疼痛服务 (TPS) 的高利用率和相关的术后阿片类药物使用的预测因素.
- 评估TPS在高风险手术患者的疼痛和阿片类药物使用管理中的有效性.
主要方法:
- 从2024年2月到2025年2月,TPS管理的345名手术患者的回顾性队列研究.
- 使用多变量线性回归分析整体术后阿片类药物使用 (MME),TPS持续时间和提供者联系情况.
- 包括诸如人口统计,疼痛灾难化,精神病学/药物使用史和手术前阿片类药物使用等预测因素.
主要成果:
- 疼痛灾难化成为最强的预测因素,与阿片类药物使用增加,TPS持续时间和提供者联系相关.
- 活性尼古丁使用和更高的手术前阿片类药物剂量 (≥50MME/天) 也预测了更大的术后阿片类药物消费.
- 尽管有高风险的患者资料 (94%的慢性疼痛,69%的精神病诊断,79%的药物使用史),只有3.2%的患者在服用较高的阿片类药物剂量后获得了出院.
结论:
- 疼痛灾难化和物质使用指标是增加TPS利用和阿片类药物消费的关键预测指标.
- 术前心理社会查对于优化风险手术群体的疼痛管理策略至关重要.
- 资源充足的TPS计划在控制阿片类药物剂量升级方面表现出有效性,即使在高风险患者中也是如此.
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