Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA.
J Clin Pharm Ther. 2020 Feb;45(1):169-178. doi: 10.1111/jcpt.13052. Epub 2019 Oct 6.
The opioid doses on post-operative day 1 (POD1) is a major predictor of recovery in patients following lumbar spine surgery (LSS). However, the opioid doses vary widely in clinical practice. Thus, the objective of this study was to explore the associations between opioid doses on POD1, pain and function during a hospital stay in patients following LSS.
This study used medical records of patients who underwent LSS between January 2007 and March 2018. The patients were divided into three groups (high, medium and low dose) according to the amount of opioid (oral morphine equivalents; OME) taken on POD1. A propensity score matching across the three groups was performed to account for main confounding factors related to the opioid dose, pain intensity and gait distance, which identified 114 matched patients in each group. The difference of pain intensity and gait distance between the groups on POD1 was analysed.
The OME in each group on POD1 was 168.75 ± 69.50 mg (high), 65.92 ± 13.28 mg (medium) and 16.90 ± 9.80 mg (low) (P < .0001). Pain intensity on the postoperative day 2 (POD2) and 3 (POD3) was not different between the groups (P > .05). Gait distance on POD2 and POD3 was different between the groups but did not reach the adjusted statistically significant level of 0.017: high (170.3 ± 152.77 feet) versus medium (247.57 ± 216.65 feet) dose on POD2 (P = .04); high (179.31 ± 135.722 feet) versus low (230.94 ± 145.74 feet) dose on POD3 (P = .03); and medium (196.98 ± 159.42 feet) versus low (261.00 ± 161.03 feet) dose on POD3 (P = .09).
The findings indicated that high dose opioids on POD1 did not translate into better outcomes of pain and gait in patients following LSS. In fact, patients in medium and low dose groups walked a greater distance on POD2 and POD3. Use of a functional outcome such as gait should be considered to optimize opioid dose effects.
术后第 1 天（POD1）的阿片类药物剂量是腰椎脊柱手术后患者康复的主要预测因素。然而，在临床实践中，阿片类药物的剂量差异很大。因此，本研究的目的是探讨腰椎脊柱手术后患者 POD1 时的阿片类药物剂量、疼痛和功能之间的关系。
本研究使用了 2007 年 1 月至 2018 年 3 月期间接受腰椎脊柱手术的患者的病历。根据 POD1 时服用的阿片类药物（口服吗啡当量；OME）量，患者被分为三组（高、中、低剂量）。通过对三组进行倾向评分匹配，以考虑与阿片类药物剂量、疼痛强度和步态距离相关的主要混杂因素，每组匹配了 114 名患者。分析了 POD1 时各组之间疼痛强度和步态距离的差异。
每组 POD1 时的 OME 分别为 168.75±69.50mg（高）、65.92±13.28mg（中）和 16.90±9.80mg（低）（P<0.0001）。第 2 天（POD2）和第 3 天（POD3）的疼痛强度在各组之间无差异（P>.05）。POD2 和 POD3 时的步态距离在各组之间存在差异，但未达到统计学显著水平 0.017：高（170.3±152.77 英尺）与中（247.57±216.65 英尺）剂量在 POD2 时（P=0.04）；高（179.31±135.722 英尺）与低（230.94±145.74 英尺）剂量在 POD3 时（P=0.03）；中（196.98±159.42 英尺）与低（261.00±161.03 英尺）剂量在 POD3 时（P=0.09）。
研究结果表明，POD1 时高剂量阿片类药物并不能转化为腰椎脊柱手术后患者疼痛和步态的更好结果。事实上，中剂量和低剂量组患者在 POD2 和 POD3 时行走的距离更大。应该考虑使用步态等功能结果来优化阿片类药物剂量的效果。
