Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada.
Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.
J Burn Care Res. 2022 May 17;43(3):710-715. doi: 10.1093/jbcr/irab179.
Patients with burn injuries require large doses of opioids and gabapentinoids to achieve pain control and are often discharged from hospital with similar amounts. This study aimed to identify patient risk factors that increase analgesic requirements among patients with burn injuries and to determine the relationship between opioid and gabapentinoid use. Patient charts from July 1, 2015 to 2018 were reviewed retrospectively to determine analgesic requirements 24 hours before discharge. Linear mixed regression models were performed to determine patient risk factors (age, gender, history of substance misuse, TBSA of burn, length of stay in hospital, history of psychiatric illness, or surgical treatment) that may increase analgesic requirements. This study found that patients with a history of substance misuse (P = .01) or who were managed surgically (P = .01) required higher doses of opioids at discharge. Similarly, patients who had undergone surgical debridement required more gabapentinoids (P < .001). For every percent increase in TBSA, patients also required 14 mg more gabapentinoids (P = .01). In contrast, older patients (P = .006) and those with a longer hospital stay (P = .009) required fewer amounts of gabapentinoids before discharge. By characterizing factors that increase analgesic requirements at discharge, burn care providers may have a stronger understanding of which patients are at greater risk of developing chronic opioid or gabapentinoid misuse. The quantity and duration of analgesics prescribed at discharge may then be tailored according to these patient specific risk factors.
烧伤患者需要大剂量的阿片类药物和加巴喷丁类药物来控制疼痛，并且通常出院时也会携带类似剂量的药物。本研究旨在确定增加烧伤患者镇痛需求的患者风险因素，并确定阿片类药物和加巴喷丁类药物使用之间的关系。回顾性分析 2015 年 7 月 1 日至 2018 年的患者病历，以确定出院前 24 小时的镇痛需求。进行线性混合回归模型以确定可能增加镇痛需求的患者风险因素（年龄、性别、物质滥用史、烧伤总面积、住院时间、精神病史或手术治疗）。本研究发现，有物质滥用史（P =.01）或接受手术治疗的患者（P =.01）在出院时需要更高剂量的阿片类药物。同样，接受手术清创的患者需要更多的加巴喷丁类药物（P <.001）。烧伤总面积每增加 1%，患者还需要额外 14 毫克的加巴喷丁类药物（P =.01）。相比之下，年龄较大的患者（P =.006）和住院时间较长的患者（P =.009）在出院前需要更少剂量的加巴喷丁类药物。通过描述增加出院时镇痛需求的因素，烧伤护理提供者可能更深入地了解哪些患者更有可能出现慢性阿片类药物或加巴喷丁类药物滥用的风险。然后可以根据这些患者特定的风险因素调整出院时开具的镇痛药的数量和持续时间。
