Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Monash University, Commercial Rd, Melbourne, VIC 3004, Australia.
Br J Anaesth. 2012 Nov;109(5):797-803. doi: 10.1093/bja/aes261. Epub 2012 Aug 21.
The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia.
Matched cohorts of patients from Hong Kong (n=68) and Australia (n=68) were recruited. Patient attitudes and expectations to pain management documented. After operation, all patients received i.v. morphine using a patient-controlled analgesia device. Postoperative opioid consumption, pain intensity, and incidence of opioid-related side-effects were recorded.
The average (sd) opioid requirement (i.v. morphine equivalent) at 72 h after surgery was significantly less among Chinese patients [86.8 (62.6) mg (95% CI 71.8, 101.8)] compared with Caucasian patients [130.6 (71.9) mg, (P<0.0005) (95% CI 113.4, 147.8)]. Numeric rating scale pain score (0-10) was, however, higher in Chinese patients compared with Caucasian Australians, 5.3 (2.7) vs 4.4 (2.3) (P=0.029). The incidence of pruritus among Chinese patients was significantly higher than Caucasians at 24-48 h (P=0.001) and 48-72 h (P=0.001). Chinese patients also reported a strong preference for others to manage their pain, and their nurse carers were more likely to expect severe pain after surgery.
Chinese patients in Hong Kong required less opioid and experienced greater pain intensity and pruritus than Caucasian patients. Clinicians should consider differences in the side-effect profile of morphine and patient expectations related to pain control when planning postoperative analgesia for patients of Chinese ethnicity.
种族与早期阿片类药物使用之间的关系尚未得到充分理解。我们的前瞻性队列研究检验了香港的华裔患者与澳大利亚的白种人患者相比，在接受大型腹部手术后是否需要更少的阿片类药物。
从香港（n=68）和澳大利亚（n=68）招募了匹配的患者队列。记录患者对疼痛管理的态度和期望。手术后，所有患者均使用静脉注射吗啡自控镇痛装置接受静脉注射吗啡。记录术后阿片类药物的使用量、疼痛强度和阿片类药物相关副作用的发生率。
与白种人患者[130.6（71.9）mg，（P<0.0005）（95% CI 113.4, 147.8）]相比，华裔患者[86.8（62.6）mg，（95% CI 71.8, 101.8）]在手术后 72 小时的阿片类药物需求量（静脉注射吗啡等效物）显著减少（P<0.0005）。然而，华裔患者的数字评分量表疼痛评分（0-10）高于澳大利亚白种人，分别为 5.3（2.7）和 4.4（2.3）（P=0.029）。在术后 24-48 小时（P=0.001）和 48-72 小时（P=0.001），华裔患者瘙痒的发生率明显高于白种人。华裔患者还表示强烈希望他人管理他们的疼痛，而且他们的护士护理人员更有可能预期手术后会出现严重疼痛。
香港的华裔患者需要的阿片类药物较少，疼痛强度和瘙痒程度高于白种人患者。在为华裔患者制定术后镇痛计划时，临床医生应考虑吗啡的副作用特征和与疼痛控制相关的患者期望方面的差异。
