Department of Anaesthesia, Intensive Care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, 48 Bd Sérurier, 75019, Paris, France.
Paris Diderot University, Paris, France.
Eur Spine J. 2019 Jun;28(6):1257-1264. doi: 10.1007/s00586-019-05886-6. Epub 2019 Jan 31.
The aim of this study was to investigate the opioid-sparing effect of a cooling brace after surgical correction of idiopathic surgery in children.
We compared two consecutive cohorts of patients before and after introducing this technique in our institution. Management of patients was standardized. The primary objective of the study was to investigate the morphine consumption during the first postoperative day. Secondary outcomes were opioid consumption at day 3, pain intensity (at days 1 and 3), the mobilization in the standing position and duration of hospitalization.
This study included 23 and 22 patients in the control and the cooling cohorts. Cooling brace was associated with a significant decrease in morphine consumption at day 1 (1.7 [0.9, 3.3] versus 1.2 [0.5, 3.2] mg kg, P = 0.02) and day 3 (2.5 [0.5, 6.7] versus 1.2 [0.9, 2.5] mg kg, P = 0.003), and a reduction in duration of hospitalization (4 [3, 6] versus 3 [3, 4] days, P = 0.004). However, no difference was found on the pain intensity or the percentage of patient mobilized in the standing position. Number of level fused and intraoperative opioid consumption were also different between the two cohorts. However, multivariate analysis found only the use of the cooling brace as significantly associated with opioid consumption at day 1.
The use of this cooling brace allows decreasing the opioid use after surgical correction of idiopathic surgery in children. The current results strongly suggest an interest of this technique in the postoperative management of patients. These slides can be retrieved under Electronic Supplementary Material.
本研究旨在探讨在儿童特发性脊柱侧凸手术后使用冷却支具对减少阿片类药物使用的效果。
我们比较了在我们医院引入该技术前后连续的两批患者。对患者的管理进行了标准化。该研究的主要目的是研究术后第一天的吗啡消耗量。次要结果是术后第 3 天的阿片类药物消耗量、疼痛强度(第 1 天和第 3 天)、站立位的活动能力和住院时间。
本研究中,对照组和冷却组分别有 23 例和 22 例患者。使用冷却支具后,第 1 天(1.7[0.9,3.3]mg/kg 比 1.2[0.5,3.2]mg/kg,P=0.02)和第 3 天(2.5[0.5,6.7]mg/kg 比 1.2[0.9,2.5]mg/kg,P=0.003)的吗啡消耗量显著减少,住院时间也缩短(4[3,6]天比 3[3,4]天,P=0.004)。然而,在疼痛强度或站立位活动的患者比例方面,两组之间没有差异。两组之间融合的节段数和术中阿片类药物的使用量也不同。然而,多变量分析发现,只有使用冷却支具与术后第 1 天的阿片类药物消耗显著相关。
在儿童特发性脊柱侧凸手术后使用这种冷却支具可以减少阿片类药物的使用。目前的结果强烈表明,该技术在患者术后管理中具有一定的应用价值。这些幻灯片可在电子补充材料中检索。