温哥华综合医院择期剖腹手术后硬膜外镇痛对术后阿片类药物需求的影响。
Effect of epidural analgesia on postoperative opioid requirements following elective laparotomies performed at Vancouver General Hospital.
机构信息
Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, British Columbia, V5Z 1M9, Canada.
Department of Surgery, College of Medicine, Majmaah University, Industrial Area, Al Majma'ah, 15341, Saudi Arabia.
出版信息
Am J Surg. 2021 Jun;221(6):1228-1232. doi: 10.1016/j.amjsurg.2021.03.025. Epub 2021 Mar 17.
BACKGROUND
Enhanced recovery pathways aim to reduce postoperative opioid use and opioid-related complications. These pathways often include epidural analgesia (EA). This study examines postoperative opioid use after elective laparotomy with and without EA.
METHODS
Retrospective chart review of elective laparotomies performed by General Surgery at a tertiary academic center during 2017 was completed. Primary outcome was postoperative opioid usage. Secondary outcomes were time to mobilization, duration of urinary catheterization and postoperative ileus.
RESULTS
Among 236 patients, 213 (90%) received EA. There was no significant difference in mean total oral morphine equivalent (OME) usage between EA and non-EA groups. Mean OME use on postoperative day three was higher in the EA group (38.0 vs 22.4 mg, p = 0.02). On multivariate analysis, preoperative opioid use was associated with increased postoperative OME consumption (regression coefficient 147.5, p < 0.001).
CONCLUSIONS
In this cohort, epidural analgesia did not reduce postoperative opioid consumption.
背景
强化康复途径旨在减少术后阿片类药物的使用和与阿片类药物相关的并发症。这些途径通常包括硬膜外镇痛（EA）。本研究检查了行择期剖腹术时使用和不使用 EA 的患者的术后阿片类药物使用情况。
方法
回顾性分析了 2017 年在一家三级学术中心由普通外科完成的择期剖腹术的图表。主要结局是术后阿片类药物的使用情况。次要结局是活动时间、导尿时间和术后肠梗阻。
结果
在 236 名患者中，有 213 名（90%）接受了 EA。EA 组和非 EA 组的平均口服吗啡等效剂量（OME）使用量无显著差异。EA 组术后第 3 天的 OME 使用量较高（38.0 与 22.4mg，p=0.02）。多变量分析显示，术前阿片类药物的使用与术后 OME 消耗的增加相关（回归系数 147.5，p<0.001）。
结论
在本队列中，硬膜外镇痛并未减少术后阿片类药物的使用。
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