低血清维生素D水平与术后疼痛加剧及阿片类药物需求量增加无关：一项历史性队列研究。

Low serum vitamin D levels are not associated with increased postoperative pain and opioid requirements: a historical cohort study.

作者信息

Bose Somnath, Khanna Ashish, You Jing, Arora Lovkesh, Qavi Shahbaz, Turan Alparslan

机构信息

Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.

出版信息

Can J Anaesth. 2015 Jul;62(7):770-6. doi: 10.1007/s12630-015-0357-4. Epub 2015 Mar 10.

DOI:10.1007/s12630-015-0357-4

PMID:25752462

Abstract

PURPOSE

Vitamin D deficiency has been associated with chronic non-specific musculoskeletal pain syndromes; however, studies are lacking with respect to its relationship with postoperative pain. We tested the hypothesis that a lower preoperative vitamin D level is associated with increased postoperative pain and/or opioid consumption in morbidly obese patients who had laparoscopic bariatric surgery.

METHODS

Data from 185 patients who underwent laparoscopic bariatric surgery at the Cleveland Clinic from 2005-2009 and had a vitamin D level checked within three months of their surgery were included in the analysis. We assessed the relationship between vitamin D levels and the time-weighted average (TWA) of pain scores and total opioid consumption using multivariable regression models adjusted for potential confounders. As a secondary analysis, we compared the TWA of pain scores and opioid consumption between patients who were vitamin D deficient (≤ 20 ng·mL(-1)) and those who were not (vitamin D > 20 ng·mL(-1)).

RESULTS

The mean (SD) TWA pain score was 3.8 (1.5) and the median interquartile range [IQR] total opioid consumption (morphine equivalent) was 15.6 [18.2] mg during the first 72 hr postoperatively. The median [IQR] vitamin D concentration was 21.8 [17.1] ng·mL(-1). The vitamin D level was not significantly associated with either the TWA pain score (Pearson correlation: -0.003; 97.5% confidence interval [CI]: -0.17 to 0.16) or opioid consumption (Spearman correlation: -0.13; 97.5% CI: -0.30 to 0.03). After adjusting for confounders, the estimated average change in TWA pain score was 0.01 (97.5% CI: -0.08 to 0.11) for a five-unit increase in vitamin D (P = 0.77). The estimated ratio of geometric means of total opioid consumption was 0.94 (97.5% CI: 0.86 to 1.03) for a five-unit increase in vitamin D concentration (P = 0.12). No difference was found between patients with vitamin D concentrations > 20 ng·mL(-1) and ≤ 20 ng·mL(-1) in either TWA pain score (P = 0.91) or total opioid consumption (P = 0.18).

CONCLUSION

We did not find any association between preoperative vitamin D levels and postoperative pain scores/opioid consumption in morbidly obese patients undergoing bariatric surgery.

摘要

目的

维生素D缺乏与慢性非特异性肌肉骨骼疼痛综合征相关；然而，关于其与术后疼痛的关系的研究尚缺。我们检验了这样一个假设，即术前维生素D水平较低与接受腹腔镜减肥手术的病态肥胖患者术后疼痛增加和/或阿片类药物消耗量增加有关。

方法

分析纳入了2005年至2009年在克利夫兰诊所接受腹腔镜减肥手术且在术后三个月内检查了维生素D水平的185例患者的数据。我们使用针对潜在混杂因素进行调整的多变量回归模型评估了维生素D水平与疼痛评分的时间加权平均值（TWA）以及阿片类药物总消耗量之间的关系。作为次要分析，我们比较了维生素D缺乏（≤20 ng·mL⁻¹）和非缺乏（维生素D＞20 ng·mL⁻¹）患者的疼痛评分TWA和阿片类药物消耗量。

结果

术后72小时内，平均（标准差）TWA疼痛评分为3.8（1.5），阿片类药物总消耗量（吗啡当量）的中位数四分位间距[IQR]为15.6[18.2]mg。维生素D浓度的中位数[IQR]为21.8[17.1]ng·mL⁻¹。维生素D水平与TWA疼痛评分（Pearson相关性：-0.003；97.5%置信区间[CI]：-0.17至0.16）或阿片类药物消耗量（Spearman相关性：-0.13；97.5%CI：-0.30至0.03）均无显著相关性。在对混杂因素进行调整后，维生素D每增加五个单位，TWA疼痛评分的估计平均变化为0.01（97.5%CI：-0.08至0.11）（P = 0.77）。维生素D浓度每增加五个单位，阿片类药物总消耗量的几何均数估计比值为0.94（97.5%CI：0.86至1.03）（P = 0.12）。维生素D浓度＞20 ng·mL⁻¹和≤20 ng·mL⁻¹的患者在TWA疼痛评分（P = 0.91）或阿片类药物总消耗量（P = 0.18）方面均未发现差异。