Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA, USA.
Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA.
Korean J Anesthesiol. 2020 Jun;73(3):219-223. doi: 10.4097/kja.19370. Epub 2019 Nov 5.
Several hospitals have implemented a multidisciplinary Acute Pain Service (APS) to execute surgery-specific opioid sparing analgesic pathways. Implementation of an anesthesia attending-only APS has been associated with decreased postoperative opioid consumption, time to ambulation, and time to solid food intake for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. In this study, we evaluated the impact of introducing an APS trainee on postoperative opioid consumption in patients undergoing hyperthermic intraperitoneal chemotherapy during POD 0-3.
We performed a retrospective propensity-matched cohort study where we compared opioid consumption and hospital length of stay among two historical cohorts: attending-only APS service versus service involving a regional anesthesia fellow.
In the matched cohorts, the median postoperative day (POD) 0-3 opioid use [25%, 75% quartile] for the single attending and trainee involvement cohort were 38.5 mg morphine equivalents (MEQ) [14.1 mg, 106.3 mg] and 50.4 mg MEQ [28.4 mg, 91.2 mg], respectively. The median difference was -9.8 mg MEQ (95% CI -30.7-16.5 mg; P = 0.43). There was no difference in hospital length of stay between both cohorts (P = 0.67).
We found that the addition of a regional anesthesia fellow to the APS team was not associated with statistically significant differences in total opioid consumption or hospital length of stay in this surgical population. The addition of trainees to the infrastructure, with vigilant supervision, is not associated with change in outcomes.
多家医院实施了多学科急性疼痛服务（APS），以执行针对特定手术的减少阿片类药物镇痛途径。实施仅麻醉主治医生参与的 APS 与术后阿片类药物消耗减少、术后下床时间和接受腹腔热灌注化疗的细胞减灭术患者开始摄入固体食物时间有关。在这项研究中，我们评估了在术后 0-3 天期间引入 APS 学员对接受腹腔热灌注化疗患者术后阿片类药物消耗的影响。
我们进行了一项回顾性倾向匹配队列研究，其中我们比较了两个历史队列的阿片类药物消耗和住院时间：仅主治医生参与的 APS 服务与涉及区域麻醉住院医师的服务。
在匹配的队列中，单一主治医生和培训师参与组术后第 0-3 天的中位数阿片类药物使用量[25%，75%四分位数]分别为 38.5 毫克吗啡当量（MEQ）[14.1 毫克，106.3 毫克]和 50.4 毫克 MEQ [28.4 毫克，91.2 毫克]。中位数差异为-9.8 毫克 MEQ（95%CI-30.7-16.5 毫克；P=0.43）。两组的住院时间无差异（P=0.67）。
我们发现，在 APS 团队中增加一名区域麻醉住院医师并没有在这个手术人群中导致总阿片类药物消耗或住院时间的统计学显著差异。在基础设施中增加培训师，并进行严密监督，不会导致结果发生变化。
