Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA.
Clin Transplant. 2020 Oct;34(10):e14006. doi: 10.1111/ctr.14006. Epub 2020 Sep 4.
Opioid use after kidney transplant has been shown to be a risk factor for chronic opioid use, which leads to an increased risk of mortality. The purpose of this study was to evaluate the early impact of a multimodal pain regimen and education quality improvement program on opioid use after kidney transplant 2 months after implementation. This was a retrospective, single-center analysis of post-operative opioid use, comparing the average daily Morphine milligram equivalents (MME) of the patients who received education on opioids and a multimodal pain regimen (preoperative TAP/QL block, scheduled APAP and gabapentin) compared to a historical control group. Despite having no differences in pre-transplant opioid exposure, daily and overall inpatient opioid utilization was significantly reduced in the multimodal pain protocol cohort (38.6 vs 8.0 MME/day; P < .001); 5% of patients in the multimodal pain protocol cohort were discharged with an opioid prescription, compared to 96% of controls (P < .001). Our early results demonstrate that a multimodal pain protocol can effectively and dramatically reduce short-term opioid utilization in kidney transplant recipients.
肾移植后使用阿片类药物已被证实是慢性阿片类药物使用的风险因素，这会增加死亡率。本研究旨在评估多模式疼痛方案和教育质量改进计划在实施后 2 个月对肾移植后阿片类药物使用的早期影响。这是一项回顾性、单中心的术后阿片类药物使用分析，比较了接受阿片类药物教育和多模式疼痛方案（术前 TAP/QL 阻滞、计划 APAP 和加巴喷丁）的患者的平均每日吗啡毫克当量（MME）与历史对照组。尽管术前阿片类药物暴露无差异，但多模式疼痛方案组的每日和总体住院期间阿片类药物使用率显著降低（38.6 对 8.0 MME/天；P<.001）；多模式疼痛方案组 5%的患者出院时开具了阿片类药物处方，而对照组为 96%（P<.001）。我们的早期结果表明，多模式疼痛方案可有效且显著减少肾移植受者短期阿片类药物的使用。
