Department of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, Chapel Hill, NC, USA.
Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.
Clin Transplant. 2021 Apr;35(4):e14240. doi: 10.1111/ctr.14240. Epub 2021 Feb 22.
The use of non-opioid analgesics following surgery has proven beneficial in managing pain and decreasing adverse outcomes following surgery. Data assessing outcomes related to opioid use is limited in kidney transplant recipients (KTRs). We evaluated the effectiveness of implementing a reduced to no opioid use protocol in KTRs. This retrospective cohort study included adult KTRs between January 2017 and July 2019 with a multimodal analgesic protocol (MAP), focused on limiting opioids, implemented in August 2018. We compared analgesic requirements in morphine milligram equivalents (MME) during transplant admissions between the MAP cohort and traditional cohort. There were 217 KTRs who met the criteria. Inpatient opioid use was significantly reduced in the MAP cohort (16.5 ± 19.2 MME/day vs 24.7 ± 19.7 MME/day; P <.05) with no significant difference in pain scores. No use of opioids within six months of discharge was significantly increased in the MAP cohort (50% vs 7%; P <.001), and there were no reported deaths at six months in either cohort. The use of multimodal analgesia is beneficial in KTRs to provide adequate pain control with limited to no exposure of opioids during admission or at discharge.
术后使用非阿片类镇痛药已被证明可有效控制疼痛并降低术后不良结局。在肾移植受者（KTR）中，评估与阿片类药物使用相关结局的数据有限。我们评估了在 KTR 中实施减少或不使用阿片类药物方案的效果。这项回顾性队列研究纳入了 2017 年 1 月至 2019 年 7 月间的成年 KTR，他们使用了一种多模式镇痛方案（MAP），重点是限制阿片类药物的使用，该方案于 2018 年 8 月实施。我们比较了 MAP 队列和传统队列中移植入院期间吗啡毫克当量（MME）的镇痛需求。共有 217 名 KTR 符合标准。MAP 队列中的住院阿片类药物使用显著减少（16.5±19.2 MME/天 vs 24.7±19.7 MME/天；P<.05），但疼痛评分无显著差异。MAP 队列中出院后 6 个月内无阿片类药物使用的比例显著增加（50% vs 7%；P<.001），且两个队列在 6 个月时均无报告死亡。多模式镇痛在 KTR 中是有益的，它可以在住院或出院期间提供足够的疼痛控制，同时限制或不使用阿片类药物。
