Department of Pharmacy Services, University of California Davis Medical Center, Sacramento, USA.
Firefighters Burn Institute, University of California Davis Medical Center, Sacramento, USA.
J Burn Care Res. 2021 Sep 30;42(5):986-990. doi: 10.1093/jbcr/irab001.
Opioids are the mainstay of treatment for burn pain. However, these medications may be associated with respiratory depression and dependence. Multimodal analgesia is an alternative method that utilizes both opioid and nonopioid medications with different mechanisms. This study examines the impact of multimodal therapy for postoperative pain control in a burn intensive care unit. This was a retrospective cohort study of patients admitted to the burn unit at a tertiary medical center. Consecutively admitted patients with burns greater than or equal to 10% TBSA and intensive care unit length of stay greater than 7 days were eligible for inclusion (2012-2018). Patients were excluded if they received an opioid infusion greater than 48 hours. Patients treated with multimodal analgesia were compared to those treated with opioids alone. Data were calculated for 5 days after surgery. There were 98 patients in the nonmultimodal group and 97 in the multimodal group. Mean cumulative opioid dose was lower in the multimodal group (1028.7 mg vs 1423.2 mg, P = .0031). Patients with greater than 20% burns had a larger reduction in mean opioid equivalents in the multimodal group (1106 vs 1594 mg, P = .009) compared to patients with burns less than 20% (940 vs 1282 mg, P = .058). There was no difference in mean pain scores on postoperative day 5 (6.2 ± 2.2 vs 5.5 ± 2.3, P = .07) or at intensive care unit discharge (4.7 ± 2.4 vs 4.7 ± 2.8, P = .99). The use of multimodal analgesia significantly reduced cumulative opioid equivalent dose without compromising pain control. .
阿片类药物是治疗烧伤疼痛的主要药物。然而，这些药物可能与呼吸抑制和依赖有关。多模式镇痛是一种替代方法，它利用具有不同作用机制的阿片类药物和非阿片类药物。本研究探讨了烧伤重症监护病房多模式治疗对术后疼痛控制的影响。这是一项对一家三级医疗中心烧伤病房住院患者的回顾性队列研究。连续收治烧伤面积大于或等于 10%TBSA 和重症监护病房住院时间大于 7 天的患者符合纳入标准（2012-2018 年）。如果患者接受阿片类药物输注超过 48 小时，则将其排除在外。将接受多模式镇痛治疗的患者与单独接受阿片类药物治疗的患者进行比较。数据计算术后 5 天。非多模式组 98 例，多模式组 97 例。多模式组累积阿片类药物剂量较低（1028.7mg 比 1423.2mg，P =.0031）。烧伤面积大于 20%的患者多模式组平均阿片类等效药物剂量降低幅度更大（1106mg 比 1594mg，P =.009），烧伤面积小于 20%的患者（940mg 比 1282mg，P =.058）。术后第 5 天（6.2±2.2 比 5.5±2.3，P =.07）和重症监护病房出院时（4.7±2.4 比 4.7±2.8，P =.99）平均疼痛评分无差异。使用多模式镇痛显著降低累积阿片类等效药物剂量，而不影响疼痛控制。
