连续股神经导管可减少老年髋部骨折患者的阿片类药物相关副作用并提高家庭处置率。

Continuous Femoral Nerve Catheters Decrease Opioid-Related Side Effects and Increase Home Disposition Rates Among Geriatric Hip Fracture Patients.

作者信息

Arsoy Diren, Gardner Michael J, Amanatullah Derek F, Huddleston James I, Goodman Stuart B, Maloney William J, Bishop Julius A

机构信息

Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA.

出版信息

J Orthop Trauma. 2017 Jun;31(6):e186-e189. doi: 10.1097/BOT.0000000000000854.

DOI:10.1097/BOT.0000000000000854

PMID:28538458

Abstract

OBJECTIVE

To evaluate the effect of continuous femoral nerve catheter (CFNC) for postoperative pain control in geriatric proximal femur fractures compared with standard analgesia (SA) treatment.

DESIGN

Retrospective comparative study.

SETTING

Academic Level 1 trauma center.

PATIENTS/PARTICIPANTS: We retrospectively identified 265 consecutive geriatric hip fracture patients who underwent surgical treatment.

INTERVENTION

One hundred forty-nine patients were treated with standard analgesia without nerve catheter whereas 116 patients received an indwelling CFNC.

MAIN OUTCOME MEASUREMENT

Daily average preoperative and postoperative pain scores, daily morphine equivalent consumption, opioid-related side effects and discharge disposition.

RESULTS

Patients with CFNC patients reported lower average pain scores preoperatively (1.9 ± 1.7 for CFNC vs. 4.7 ± 2 for SA; P < 0.0001), on postoperative day 1 (1.5 ± 1.6 for CFNC vs. 3 ± 1.7 for SA; P < 0.0001) and postoperative day 2 (1.2 ± 1.5 for CFNC vs. 2.6 ± 2.1 for SA; P < 0.0001). CFNC group consumed 39% less morphine equivalents on postoperative day 1 (4.4 ± 5.8 mg for CFNC vs. 7.2 ± 10.8 mg for SA; P = 0.005) and 50% less morphine equivalent on postoperative day 2 (3.4 ± 4.4 mg for CFNC vs. 6.8 ± 13 mg for SA; P = 0.105). Patients with CFNC had a lower rate of opioid-related side effects compared with patients with SA (27.5% for CFNC vs. 47% for SA; P = 0.001). More patients with CFNC were discharged to home with or without health services than patients with SA (15% for CFNC vs. 6% for SA; P = 0.023).

CONCLUSION

Continuous femoral nerve catheter decreased daily average patient-reported pain scores, narcotic consumption while decreasing the rate of opioid-related side effects. Patients with CFNC were discharged to home more frequently.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

评估与标准镇痛（SA）治疗相比，连续股神经导管（CFNC）用于老年股骨近端骨折术后疼痛控制的效果。

设计

回顾性比较研究。

地点

一级学术创伤中心。

患者/参与者：我们回顾性确定了265例连续接受手术治疗的老年髋部骨折患者。

干预措施

149例患者接受无神经导管的标准镇痛治疗，而116例患者接受留置CFNC治疗。

主要观察指标

术前和术后每日平均疼痛评分、每日吗啡当量消耗量、阿片类药物相关副作用及出院处置情况。

结果

CFNC组患者术前平均疼痛评分较低（CFNC组为1.9±1.7，SA组为4.7±2；P<0.0001），术后第1天（CFNC组为1.5±1.6，SA组为3±1.7；P<0.0001）和术后第2天（CFNC组为1.2±1.5，SA组为2.6±2.1；P<0.0001）。CFNC组术后第1天吗啡当量消耗量减少39%（CFNC组为4.4±5.8mg，SA组为7.2±10.8mg；P=0.005），术后第2天吗啡当量消耗量减少50%（CFNC组为3.4±4.4mg，SA组为6.8±13mg；P=0.105）。与SA组患者相比，CFNC组患者阿片类药物相关副作用发生率较低（CFNC组为27.5%，SA组为47%；P=0.001）。与SA组患者相比，更多接受CFNC治疗的患者在有或无医疗服务的情况下出院回家（CFNC组为15%，SA组为6%；P=0.023）。