Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston.
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston.
JAMA Otolaryngol Head Neck Surg. 2020 Aug 1;146(8):708-713. doi: 10.1001/jamaoto.2020.1170.
The opioid epidemic has reignited interest in opioid-sparing strategies in managing pain. However, few studies have focused on opioid use during perioperative care in patients undergoing head and neck surgery with free flap reconstruction.
To examine the association between multimodal analgesia (MMA) administration and perioperative opioid requirements in patients undergoing head and neck surgery with free flap reconstruction and to investigate whether MMA alters the duration of stay in the postanesthesia care unit (PACU).
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective case-control study, data were collected between April 1, 2016, and December 31, 2017. The study was conducted at a single cancer center in the United States. Participants were 357 patients 18 years or older scheduled for head and neck surgery with free flap reconstruction.
Patients in the treatment group received oral celecoxib, gabapentin, and/or tramadol hydrochloride before surgery. Control group patients did not receive any of these medications.
The amount of opioid administered in the operating room and in the PACU was converted to morphine equivalent daily dose (MEDD) for comparison between the 2 groups. The duration of stay in the PACU was based on the start time and end time of PACU care recorded by nurses in the PACU.
In total, 149 patients (mean [SD] age, 60.3 [13.7] years; 104 [69.8%] men) were included in the treatment group, and 208 patients (mean [SD] age, 64.2 [13.6] years; 146 [70.2%] men) were included in the control group. The mean (SD) MEDD of opioid given during surgery was 51.7 (19.8) in the treatment group and 67.9 (24.7) in the control group, for a difference in the means (treatment vs control) of -16.17 (95% CI, -20.81 to -11.52). In the PACU, the mean (SD) MEDD of opioid given was 11.7 (13.3) in the treatment group and 14.9 (15.7) in the control group, for a difference in the means (treatment vs control) of -3.22 (95% CI, -6.40 to -0.03). The MMA treatment remained largely associated with reduced amount of opioid given during surgery, in the PACU, and both combined after controlling for other important factors.
This case-control study found that the patients who received MMA before head and neck surgery with free flap reconstruction required less opioid medication. The treatment group also had shorter duration of stay in the PACU compared with the control group.
阿片类药物泛滥再次引发了人们对管理疼痛的阿片类药物节约策略的兴趣。然而，很少有研究关注头颈部手术伴游离皮瓣重建患者围手术期阿片类药物的使用情况。
研究在接受头颈部手术伴游离皮瓣重建的患者中，多模式镇痛（MMA）与围手术期阿片类药物需求之间的关系，并探讨 MMA 是否会改变术后恢复室（PACU）的停留时间。
设计、地点和参与者：这是一项回顾性病例对照研究，数据收集于 2016 年 4 月 1 日至 2017 年 12 月 31 日期间。研究在美国的一家癌症中心进行。参与者为 357 名年龄在 18 岁或以上的头颈部手术伴游离皮瓣重建患者。
治疗组患者在术前接受口服塞来昔布、加巴喷丁和/或盐酸曲马多。对照组患者未服用任何这些药物。
将手术室和 PACU 中给予的阿片类药物量转换为吗啡等效日剂量（MEDD），以比较两组之间的差异。PACU 停留时间基于 PACU 护士记录的 PACU 护理开始时间和结束时间。
共纳入 149 例患者（平均[标准差]年龄 60.3[13.7]岁；104[69.8%]名男性）为治疗组，208 例患者（平均[标准差]年龄 64.2[13.6]岁；146[70.2%]名男性）为对照组。治疗组术中给予的阿片类药物 MEDD 的平均值（标准差）为 51.7（19.8），对照组为 67.9（24.7），两组之间的平均差异（治疗组与对照组）为-16.17（95%CI，-20.81 至-11.52）。在 PACU 中，治疗组给予的阿片类药物 MEDD 的平均值（标准差）为 11.7（13.3），对照组为 14.9（15.7），两组之间的平均差异（治疗组与对照组）为-3.22（95%CI，-6.40 至-0.03）。在控制其他重要因素后，MMA 治疗与手术期间、PACU 期间和两者联合使用的阿片类药物用量减少仍有很大关系。
这项病例对照研究发现，接受头颈部手术伴游离皮瓣重建的患者接受 MMA 治疗后，需要的阿片类药物较少。与对照组相比，治疗组 PACU 停留时间也较短。
