Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Racial Ethn Health Disparities. 2021 Jun;8(3):547-558. doi: 10.1007/s40615-020-00811-w. Epub 2020 Jul 3.
Perioperative pain may have deleterious effects for all patients. We aim to examine disparities in pain management for children in the perioperative period to understand whether any racial and ethnic groups are at increased risk of poor pain control.
Medical records from children ≤ 18 years of age who underwent surgery from May 2014 to May 2018 were reviewed. The primary outcome was total intraoperative morphine equivalents. The secondary outcomes were intraoperative non-opioid analgesic administration and first conscious pain score. The exposure was race and ethnicity. The associations of race and ethnicity with outcomes of interest were modeled using linear or logistic regression, adjusted for preselected confounders and covariates. Bonferroni corrections were made for multiple comparisons.
A total of 21,229 anesthetics were included in analyses. In the adjusted analysis, no racial and ethnic group received significantly more or less opioids intraoperatively than non-Hispanic (NH) whites. Asians, Hispanics, and Pacific Islanders were estimated to have significantly lower odds of receiving non-opioid analgesics than NH whites: odds ratio (OR) = 0.83 (95% confidence interval (CI): 0.70, 0.97); OR = 0.84 (95% CI: 0.74, 0.97), and OR = 0.53 (95% CI: 0.33, 0.84) respectively. Asians were estimated to have significantly lower odds of reporting moderate-to-severe pain on awakening than NH whites: OR = 0.80 (95% CI: 0.66, 0.99).
Although children of all races and ethnicities investigated received similar total intraoperative opioid doses, some were less likely to receive non-opioid analgesics intraoperatively. Asians were less likely to report moderate-severe pain upon awakening. Further investigation may delineate how these differences lead to disparate patient outcomes and are influenced by patient, provider, and system factors.
围手术期疼痛可能对所有患者都有不良影响。我们旨在研究围手术期儿童疼痛管理方面的差异，以了解是否有任何种族和族裔群体面临更高的疼痛控制不良风险。
回顾了 2014 年 5 月至 2018 年 5 月期间接受手术的≤18 岁儿童的病历。主要结局指标是总术中吗啡等效物。次要结局指标为术中非阿片类镇痛药的应用和首次清醒疼痛评分。暴露因素是种族和民族。使用线性或逻辑回归模型来评估种族和民族与感兴趣的结局之间的关联，调整了预先选择的混杂因素和协变量。对多重比较进行了 Bonferroni 校正。
共有 21229 例麻醉纳入分析。在调整后的分析中，没有任何种族和族裔群体在术中接受的阿片类药物明显多于或少于非西班牙裔（NH）白人。与 NH 白人相比，亚洲人、西班牙裔和太平洋岛民接受非阿片类镇痛药的可能性估计较低：比值比（OR）=0.83（95%置信区间（CI）：0.70，0.97）；OR=0.84（95%CI：0.74，0.97）和 OR=0.53（95%CI：0.33，0.84）。亚洲人报告醒来时中度至重度疼痛的可能性估计低于 NH 白人：OR=0.80（95%CI：0.66，0.99）。
尽管研究中所有种族和族裔的儿童接受的总术中阿片类药物剂量相似，但有些儿童接受非阿片类镇痛药的可能性较低。亚洲人报告醒来时中度至重度疼痛的可能性较低。进一步的研究可能会阐明这些差异如何导致不同的患者结局，并受患者、提供者和系统因素的影响。
