Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Korea.
Reg Anesth Pain Med. 2019 Feb;44(2):221-226. doi: 10.1136/rapm-2018-000018.
Data is insufficient to determine whether perioperative statin use increases or decreases postoperative pain. This study aimed to investigate the association between perioperative statin use and pain outcomes after total knee arthroplasty performed under spinal anesthesia.
This is a retrospective, observational study based on medical records from a tertiary hospital between January 2005 and October 2017. Medical records of patients who underwent elective total knee arthroplasty under spinal anesthesia as inpatients were analyzed. Pain outcomes were compared through postoperative day (POD) 3 in patients who were taking statins perioperatively versus patients who were not taking statins.
A total of 1088 propensity-matched participants were included in the final analysis (544 patients in the statin group and 544 patients in the non-statin group). The total morphine equivalent consumption through POD 3 was higher in the statin group than in the non-statin group (mean (SD), statin group: 525.4 (119.7) vs non-statin group: 495.3 (115.3), 95% CI of the difference: 15.9 to 44.4, p<0.001). In the linear regression analysis, the total morphine equivalent consumption through POD 3 was 30.14 mg higher in the statin group compared with the non-statin group (95% CI 15.93 to 44.35; p<0.001).
Perioperative statin use is associated with a significant increase in postoperative opioid consumption after total knee arthroplasty performed under spinal anesthesia; however, this increase was so marginal that its clinical importance remains controversial.
目前的数据不足以确定围手术期使用他汀类药物是增加还是减少术后疼痛。本研究旨在调查椎管内麻醉下全膝关节置换术后围手术期使用他汀类药物与疼痛结局的关系。
这是一项基于 2005 年 1 月至 2017 年 10 月期间一家三级医院病历的回顾性、观察性研究。分析了接受椎管内麻醉下择期全膝关节置换术的住院患者的病历。通过术后第 3 天（POD3）比较围手术期使用他汀类药物的患者与未使用他汀类药物的患者的疼痛结局。
最终分析共纳入 1088 例倾向评分匹配的参与者（他汀组 544 例，非他汀组 544 例）。他汀组 POD3 的总吗啡等效消耗量高于非他汀组（平均值（标准差），他汀组：525.4（119.7）vs 非他汀组：495.3（115.3），95%置信区间差值：15.9 至 44.4，p<0.001）。在线性回归分析中，他汀组 POD3 的总吗啡等效消耗量比非他汀组高 30.14mg（95%置信区间 15.93 至 44.35；p<0.001）。
椎管内麻醉下全膝关节置换术后围手术期使用他汀类药物与术后阿片类药物消耗显著增加相关；然而，这种增加是如此微小，其临床重要性仍存在争议。
