Li Mandy Mj, Ocay Don Daniel, Teles Alisson R, Ingelmo Pablo M, Ouellet Jean A, Pagé M Gabrielle, Ferland Catherine E
Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.
J Pain Res. 2019 May 23;12:1673-1684. doi: 10.2147/JPR.S191183. eCollection 2019.
The days following surgery are a critical period where the use of opioids predicts long-term outcomes in adults. It is currently unknown as to whether opioid consumption throughout the acute postoperative period is associated with long-term outcomes in pediatric patients. The aims of this study were to characterize opioid consumption trajectories in the acute postoperative period, identify predictors of trajectory membership and determine associations between opioid consumption trajectories and long-term patient outcomes. Medication use, pain and mental health status were assessed at baseline in adolescents with idiopathic scoliosis who were scheduled for spinal fusion surgery. Cumulative 6-hr opioid consumption was recorded for up to 5 days after spinal surgery. At 6 months after surgery, medication use, pain and functional activity were evaluated. Growth mixture modeling was used to identify opioid trajectories. One hundred and six patients were included in the study. Mean cumulative 6-hr opioid consumption in the acute postoperative period was 13.23±5.20 mg/kg. The model with the best fit contained 5 acute postoperative trajectories and a quadratic term (AIC =6703.26, BIC =6767.19). Two types of patient behaviors were identified: high opioid consumers (trajectories 4 and 5) and low opioid consumers (trajectories 1, 2 and 3). Intraoperative intrathecal morphine dose was a predictor of trajectory membership (p=0.0498). Opioid consumption during the acute postoperative period was not significantly associated with pain, functional activity or pain medication use at 6 months after surgery. In pediatric patients, intraoperative intrathecal morphine dose predicts opioid consumption in the acute postoperative period. Importantly, opioid consumption during this period does not affect long-term outcomes in pediatric patients after a spine surgery.
术后的日子是一个关键时期，在此期间使用阿片类药物可预测成人的长期预后。目前尚不清楚整个急性术后期间阿片类药物的使用是否与儿科患者的长期预后相关。本研究的目的是描述急性术后期间阿片类药物的使用轨迹，确定轨迹归属的预测因素，并确定阿片类药物使用轨迹与患者长期预后之间的关联。对计划进行脊柱融合手术的特发性脊柱侧弯青少年患者在基线时评估其药物使用、疼痛和心理健康状况。记录脊柱手术后长达5天的累计6小时阿片类药物使用量。在术后6个月，评估药物使用、疼痛和功能活动情况。采用生长混合模型来识别阿片类药物使用轨迹。106名患者纳入本研究。急性术后期间平均累计6小时阿片类药物使用量为13.23±5.20mg/kg。拟合度最佳的模型包含5条急性术后轨迹和一个二次项（AIC = 6703.26，BIC = 6767.19）。识别出两种患者行为类型：高阿片类药物使用者（轨迹4和5）和低阿片类药物使用者（轨迹1、2和3）。术中鞘内吗啡剂量是轨迹归属的预测因素（p = 0.0498）。急性术后期间的阿片类药物使用与术后6个月时的疼痛、功能活动或止痛药物使用无显著关联。在儿科患者中，术中鞘内吗啡剂量可预测急性术后期间的阿片类药物使用。重要的是，在此期间的阿片类药物使用并不影响儿科患者脊柱手术后的长期预后。
