Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Faculty of Medical Sciences, Erasmus University, Rotterdam, The Netherlands.
ANZ J Surg. 2020 Oct;90(10):1947-1952. doi: 10.1111/ans.15976. Epub 2020 May 14.
The high and increasing rate of opioid use is a serious issue in the Western world affecting the population's physical and mental health. In most cases, opioid dependency starts with prescriptions by medical professionals, so efforts aimed at reducing in-hospital opioid use should result in less long-term dependency. The aim of the current study was to evaluate the feasibility of implementing an opioid-scarce protocol as part of a new online modifiable Enhanced Recovery After Surgery (mERAS) programme.
A single-centre retrospective study was conducted comparing a cohort treated under the new opioid-scarce mERAS protocol (n = 96; May 2018-Nov 2018) to those treated under the original ERAS protocol (n = 84; November 2017-April 2018). The primary outcome was the quantity and duration of opioid use.
Fewer patients used fentanyl via intravenous patient-controlled analgesia in the mERAS group (54% versus 70%; P = 0.03). The mERAS group was also less likely to use oral oxycodone (80% versus 99%; P < 0.0001) and for a shorter duration (median 3 versus 5 days; P = 0.0002). More local anaesthetic transversus abdominis plane catheters were used in the mERAS group (34% versus 6% in the control group; P < 0.0001).
Opioid use can be significantly reduced after elective colorectal surgery by employing an opioid-scarce ERAS protocol. Further data is required to confirm the clinical benefits of this approach.
阿片类药物的高使用率不断上升是西方世界的一个严重问题，影响着人们的身心健康。在大多数情况下，阿片类药物依赖始于医疗专业人员的处方，因此，旨在减少医院内阿片类药物使用的努力应该会减少长期依赖。本研究的目的是评估实施阿片类药物匮乏方案作为新的在线改良术后恢复增强（mERAS）方案的一部分的可行性。
对一项单中心回顾性研究进行了比较，该研究比较了接受新的阿片类药物匮乏 mERAS 方案（n = 96；2018 年 5 月至 2018 年 11 月）治疗的患者与接受原始 ERAS 方案（n = 84；2017 年 11 月至 2018 年 4 月）治疗的患者。主要结局是阿片类药物使用的数量和持续时间。
在 mERAS 组中，使用静脉患者自控镇痛的芬太尼的患者较少（54%对 70%；P = 0.03）。mERAS 组也不太可能使用口服羟考酮（80%对 99%；P<0.0001），且使用时间较短（中位数 3 天对 5 天；P = 0.0002）。mERAS 组中使用的局部麻醉腹横平面导管更多（34%对对照组的 6%；P<0.0001）。
通过采用阿片类药物匮乏的 ERAS 方案，可显著减少择期结直肠手术后的阿片类药物使用。需要进一步的数据来证实这种方法的临床益处。
