Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States.
Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States.
Clin Neurol Neurosurg. 2021 Aug;207:106770. doi: 10.1016/j.clineuro.2021.106770. Epub 2021 Jun 22.
Opioids are frequently used for analgesia in patients with acute subarachnoid hemorrhage (SAH) due to a high prevalence of headache and neck pain. However, it is unclear if this practice may pose a risk for opioid dependence, as long-term opioid use in this population remains unknown. We sought to determine the prevalence of opioid use in SAH survivors, and to identify potential risk factors for opioid utilization.
We analyzed a cohort of consecutive patients admitted with non-traumatic and suspected aneurysmal SAH to an academic referral center. We included patients who survived hospitalization and excluded those who were not opioid-naïve. Potential risk factors for opioid prescription at discharge, 3 and 12 months post-discharge were assessed.
Of 240 SAH patients who met our inclusion criteria (mean age 58.4 years [SD 14.8], 58% women), 233 (97%) received opioids during hospitalization and 152 (63%) received opioid prescription at discharge. Twenty-eight patients (12%) still continued to use opioids at 3 months post-discharge, and 13 patients (6%) at 12-month follow up. Although patients with poor Hunt and Hess grades (odds ratio 0.19, 95% CI 0.06-0.57) and those with intraventricular hemorrhage (odds ratio 0.38, 95% CI 0.18-0.87) were less likely to receive opioid prescriptions at discharge, we did not find significant differences between patients who had long-term opioid use and those who did not.
Opioids are regularly used in both the acute SAH setting and immediately after discharge. A considerable number of patients also continue to use opioids in the long-term. Opioid-sparing pain control strategies should be explored in the future.
由于头痛和颈部疼痛的高患病率，阿片类药物经常用于急性蛛网膜下腔出血（SAH）患者的镇痛。然而，目前尚不清楚这种做法是否会带来阿片类药物依赖的风险，因为此类人群中长期使用阿片类药物的情况尚不清楚。我们旨在确定 SAH 幸存者中阿片类药物的使用情况，并确定阿片类药物使用的潜在危险因素。
我们分析了连续收治于一家学术转诊中心的非创伤性和疑似动脉瘤性 SAH 患者队列。我们纳入了存活住院的患者，并排除了非阿片类药物初治患者。评估了出院时、出院后 3 个月和 12 个月潜在的阿片类药物处方危险因素。
在符合纳入标准的 240 例 SAH 患者中（平均年龄 58.4 岁[标准差 14.8]，58%为女性），233 例（97%）在住院期间接受了阿片类药物治疗，152 例（63%）在出院时开具了阿片类药物处方。28 例患者（12%）在出院后 3 个月仍继续使用阿片类药物，13 例患者（6%）在 12 个月随访时仍继续使用阿片类药物。尽管具有较差的 Hunt 和 Hess 分级（优势比 0.19，95%置信区间 0.06-0.57）和伴有脑室内出血（优势比 0.38，95%置信区间 0.18-0.87）的患者出院时不太可能开具阿片类药物处方，但我们未发现长期使用阿片类药物与未使用阿片类药物的患者之间存在显著差异。
阿片类药物在急性 SAH 环境中和出院后立即经常使用。相当数量的患者在长期内也继续使用阿片类药物。未来应探索阿片类药物节约性疼痛控制策略。
