Maani Christopher V, DeSocio Peter A, Jansen Richard K, Merrell Jason D, McGhee Laura L, Young Alan, Williams James F, Tyrell Katie, Jackson Bonnie A, Serio-Melvin Maria L, Blackbourne Lorne H, Renz Evan M
United States Army Institute of Surgical Research and Burn Center at Brooke Army Medical Center, Fort Sam, Houston, Texas, USA.
J Trauma. 2011 Jul;71(1 Suppl):S114-9. doi: 10.1097/TA.0b013e3182219209.
The purpose of this case series was to review the management of burn patients who requested ultrarapid opioid detoxification under anesthesia after extended duration of narcotic use for chronic pain related to burn injury.
The treatment plan of six opioid-dependent burn patients was analyzed to assess the effectiveness of our detoxification practice to date. Demographic and clinical information was used to characterize the patient population served: age, burn size, injury severity, duration of narcotic use before detoxification intervention, and length of hospitalization stay. Daily narcotic consumption, in morphine equivalent units, was noted both before and after detoxification.
Six burn patients (average age, 31 years) underwent detoxification at the Burn Center during a hospitalization lasting between 1 day and 2 days. Average burn size was 38% total body surface area (range, 17-65); average Injury Severity Score was 30 (range, 25-38). Mean duration of narcotic use was 672 days (range, 239-1,156 days); average use of narcotics at time of detoxification was >200 units daily. Mean outpatient consumption for opioids after the intervention was minimal (<25 units/d). No complications were noted during any procedures.
The results of ultrarapid opioid detoxification under anesthesia suggests that it is safe and effective for treating opioid addiction in military burn casualties when a coordinated, multidisciplinary approach is used. Safety and effectiveness to date validate current practice and supports incorporation into clinical practice guidelines. Further clinical research is warranted to identify those patients who may benefit most from detoxification and to determine the timing of such treatment.
本病例系列的目的是回顾那些因烧伤相关慢性疼痛长期使用麻醉药品后要求在麻醉下进行超快速阿片类药物脱毒的烧伤患者的治疗情况。
分析了6例阿片类药物依赖烧伤患者的治疗方案，以评估我们目前脱毒治疗的有效性。利用人口统计学和临床信息对患者群体进行特征描述：年龄、烧伤面积、损伤严重程度、脱毒干预前麻醉药品使用时长以及住院时间。记录脱毒前后以吗啡当量单位计算的每日麻醉药品消耗量。
6例烧伤患者（平均年龄31岁）在烧伤中心住院1至2天期间接受了脱毒治疗。平均烧伤面积为体表面积的38%（范围为17%-65%）；平均损伤严重程度评分为30分（范围为25-38分）。麻醉药品平均使用时长为672天（范围为239-1156天）；脱毒时麻醉药品平均每日用量>200单位。干预后门诊阿片类药物平均消耗量极少（<25单位/天）。任何操作过程中均未出现并发症。
麻醉下超快速阿片类药物脱毒的结果表明，当采用协调一致的多学科方法时，该方法对于治疗军事烧伤伤员的阿片类药物成瘾是安全有效的。目前的安全性和有效性验证了当前的做法，并支持将其纳入临床实践指南。有必要开展进一步的临床研究，以确定那些可能从脱毒中获益最大的患者，并确定此类治疗的时机。
