Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Nîmes, France; Medical Department, Montpellier University 1, Montpellier, France.
Medical Department, Montpellier University 1, Montpellier, France; Department of Traumatology and Orthopedic Surgery, Centre Hospitalo-Universitaire (CHU) Carémeau, Nîmes, France.
J Shoulder Elbow Surg. 2021 Feb;30(2):250-257. doi: 10.1016/j.jse.2020.08.040. Epub 2020 Sep 18.
Pain control and quality of recovery (QoR) at home remains a challenge after ambulatory shoulder arthroscopy. This study aims to assess the QoR and pain relief using a sequential implementation strategy for rescue analgesic drugs.
After institutional review board approval, patients (>18 years, American Society of Anesthesiology [ASA] score 1-3 stable) scheduled for ambulatory surgery under general anesthesia with a single-shot interscalene nerve block were enrolled. After discharge, patients received standard information regarding the postoperative recovery and care consisting of a multimodal analgesic regime (acetaminophen and ketoprofen for 5 days). The first 48 postoperative hours allowed us to compare 3 different rescue drug regimes with a control group, in sequential order: tramadol (control group), tramadol + nefopam, immediate-release oxycodone (IR), and extended-release oxycodone (ER). The primary endpoint was the QoR 40 score at 48 hours after surgery. Secondary endpoints were pain relief and adverse events over a 7-day period. An intention-to-treat statistical analysis was performed with sequential analysis (as an interim analysis) every 20 patients. Results were recorded as medians and interquartiles (25-75).
We analyzed 109 patients with similar characteristics among groups. The QoR 40 scores were similar for the tramadol group (168 [161-172]), the tramadol + nefopam group (161 [151-173], P = .09), and the IR group (164 [153-169], P = .17), but higher for the ER group (176 [167-181], P = .03). Concerning adverse events, drugs were interrupted more frequently in the tramadol + nefopam group (36 %). In the ER group, a higher quality of postoperative relief was attained in the domains of pain and sleep.
The present study shows that a combination of IR and ER oxycodone over a short period of time (<48 hours) is associated with a better QoR at home after ambulatory shoulder surgery.
门诊肩关节镜手术后，患者在家中的疼痛控制和康复质量（QoR）仍然是一个挑战。本研究旨在评估使用序贯实施策略解救镇痛药物的 QoR 和疼痛缓解情况。
在机构审查委员会批准后，纳入计划在全身麻醉下接受单次肩胛上神经阻滞的门诊手术且年龄大于 18 岁、美国麻醉医师学会（ASA）评分 1-3 级稳定的患者。出院后，患者接受了有关术后恢复和护理的标准信息，包括多模式镇痛方案（5 天内使用对乙酰氨基酚和酮洛芬）。术后 48 小时内，我们比较了 3 种不同的解救药物方案与对照组，按序贯顺序为：曲马多（对照组）、曲马多+奈福泮、即释型羟考酮（IR）和缓释型羟考酮（ER）。主要终点是术后 48 小时的 QoR 40 评分。次要终点是 7 天内的疼痛缓解和不良事件。采用意向治疗统计分析，每 20 例患者进行一次序贯分析（作为中期分析）。结果以中位数和四分位数（25-75）表示。
我们分析了各组之间具有相似特征的 109 名患者。曲马多组（168 [161-172]）、曲马多+奈福泮组（161 [151-173]，P =.09）和 IR 组（164 [153-169]，P =.17）的 QoR 40 评分相似，但 ER 组的评分更高（176 [167-181]，P =.03）。关于不良事件，曲马多+奈福泮组更频繁地中断药物治疗（36%）。在 ER 组中，术后疼痛和睡眠领域的缓解质量更高。
本研究表明，在短时间内（<48 小时）使用 IR 和 ER 羟考酮联合治疗，与门诊肩关节手术后在家中获得更好的 QoR 相关。
