在成年人服用高剂量的处方阿片类药物后,阿片类药物的消费和手术后的填充
Mark C Bicket1,2,3, Michael F McGee4, Vidhya Gunaseelan1,2
1Department of Anesthesiology, University of Michigan, Ann Arbor, MI.
Journal of the American College of Surgeons
|March 13, 2026
概括
高剂量手术前阿片类药物使用导致类似的30天的术后消费,但与未使用阿片类药物的患者相比,90天处方补充量显著增加. 术后规划需要与处方者协调,以避免长期使用阿片类药物.
科学领域:
- 疼痛管理 疼痛管理
- 药理学 药理学是指药理学的学科.
- 公共卫生 公共卫生
背景情况:
- 术前高剂量阿片类药物使用在治疗术后疼痛方面存在挑战.
- 这些患者的术后阿片类药物消费和补充模式与未使用阿片类药物的个人相比,尚不清楚.
研究的目的:
- 基于手术前阿片类药物暴露的常见外科手术后,比较30天阿片类药物消费和90天处方填充模式.
- 调查高剂量手术前阿片类药物使用者是否会在术后升级使用.
主要方法:
- 成人手术患者的回顾性队列研究 (2019年1月-2022年5月),使用链接的电子健康记录和处方药监测计划数据.
- 根据手术前的阿片类药物暴露,患者被分为高剂量,低剂量或阿片类药物先验组.
- 主要终点:30天的阿片类药物消费 (氧化5毫克相当). 二级终点:90天的术后处方填充. 分析使用了调整的零膨胀负二项式模型.
主要成果:
- 在72,616名患者中,高剂量手术前阿片类药物使用者报告的30天消费量 (平均4.6片) 与未使用阿片类药物患者 (平均3.2片) 相似.
- 然而,高剂量患者的90天处方补充量 (48.3%) 与低剂量患者 (27.1%) 和未使用过阿片类药物的患者 (8.2%) 相比,显著增加.
- 在高剂量患者的手术后每日阿片类药物使用与他们的手术前水平相似或低于这些水平,这表明没有升级.
结论:
- 患有高剂量手术前阿片类药物暴露的患者表现出类似的短期 (30天) 术后阿片类药物消费,但长期 (90天) 处方补充量显著增加.
- 这些补充通常不需要增加每日剂量,超过手术前的基线水平.
- 加强外科手术期间的规划,包括与通常的处方者进行协调,对于预防碎片化和长期使用阿片类药物至关重要.
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