不同剖宫产术后镇痛方案中患者选择对阿片类药物消耗的影响：一项随机前瞻性临床试验。
Impact of patient choice for different postcesarean delivery analgesic protocols on opioid consumption: a randomized prospective clinical trial.
机构信息
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
Department of Anesthesiology, Baylor College of Medicine, Houston, Texas, USA.
出版信息
Reg Anesth Pain Med. 2019 May;44(5):578-585. doi: 10.1136/rapm-2018-100206. Epub 2019 Mar 13.
BACKGROUND
Choice of postcesarean delivery analgesic protocol may improve pain experience and reduce analgesic requirements.
METHODS
Cesarean delivery patients were randomly assigned either to choose their postcesarean delivery analgesia protocol or to have no choice and receive routine care. Choices were low (50 μg intrathecal morphine), medium (identical to routine care: 150 μg intrathecal morphine), or high (300 μg intrathecal morphine with 600 mg oral gabapentin). All groups received scheduled acetaminophen and ibuprofen. The primary outcome was oxycodone requirements 0-48 hours postdelivery in those offered versus not offered a choice.
RESULTS
Of 160 women enrolled, 120 were offered a choice and 40 were not offered a choice. There was no difference in oxycodone requirements or pain associated with choice, but those who had a choice expressed more satisfaction than those who did not have a choice (mean (95% CI) difference 5% (0% to 10 %), p=0.005). In the choice group, the high dose group required more oxycodone (5 (0 to 15) mg 0-24 hours after delivery and 15 (10 to 25) mg at 24-48 hours; p=0.05 and p=0.001) versus the low and medium groups. The low dose group had less pruritus (p=0.001), while the high dose group had more vomiting (p=0.01) requiring antiemetic treatment (p=0.04).
CONCLUSION
Having a choice compared with no choice routine care did not reduce oxycodone requirements or pain scores. However, women have insight into their analgesic needs; women offered a choice and who chose the higher dose analgesic protocol required more oxycodone, and women who chose the lower dose protocol required less oxycodone. Despite providing additional analgesic (six times more intrathecal morphine plus gabapentin in high dose vs low dose protocols), we still did not equalize postcesarean oxycodone requirement differences between groups.
TRIAL REGISTRATION NUMBER
NCT02605187.
背景
选择剖宫产术后镇痛方案可能会改善疼痛体验并减少镇痛需求。
方法
将剖宫产患者随机分为选择自己的剖宫产术后镇痛方案或不选择而接受常规护理。选择包括低剂量（50μg鞘内吗啡）、中剂量（与常规护理相同：150μg鞘内吗啡）或高剂量（300μg鞘内吗啡加 600mg 口服普瑞巴林）。所有组均接受预定的对乙酰氨基酚和布洛芬治疗。主要结局是在提供选择与不提供选择的情况下，产后 0-48 小时的羟考酮需求。
结果
在纳入的 160 名女性中，120 名提供了选择，40 名未提供选择。在羟考酮需求或与选择相关的疼痛方面，两组之间没有差异，但有选择的患者比没有选择的患者表达了更高的满意度（平均（95%CI）差异 5%（0%至 10%），p=0.005）。在选择组中，高剂量组需要更多的羟考酮（产后 0-24 小时 5（0 至 15）mg，24-48 小时 15（10 至 25）mg；p=0.05 和 p=0.001）与低剂量和中剂量组相比。低剂量组瘙痒较少（p=0.001），而高剂量组呕吐较多（p=0.01），需要止吐治疗（p=0.04）。
结论
与常规护理相比，有选择与无选择对降低羟考酮需求或疼痛评分没有影响。然而，女性对自己的镇痛需求有洞察力；选择更高剂量镇痛方案的女性需要更多的羟考酮，而选择较低剂量方案的女性需要更少的羟考酮。尽管提供了更多的镇痛药物（高剂量组与低剂量组相比，鞘内吗啡加普瑞巴林六倍），我们仍然无法使各组之间的剖宫产术后羟考酮需求差异均等化。
试验注册号
NCT02605187。
Zotero 插件