McCarthy Robert J, Adams Ashley Meng, Sremac Amanda C, Kreider Wendy Jo, Pelletier Pete L, Buvanendran Asokumar
Anesthesiology, Rush University, Chicago, Illinois, USA
Anesthesiology, Rush University, Chicago, Illinois, USA.
Reg Anesth Pain Med. 2021 Dec;46(12):1067-1075. doi: 10.1136/rapm-2021-102910. Epub 2021 Sep 22.
Descriptions of opioid use trajectories and their association with postsurgical pain and opioid consumption are limited. We hypothesized that trajectories of opioid consumption in the first 28 days following surgery would be associated with unique patterns of pain and duration of opioid use.
A prospective longitudinal cohort of patients undergoing elective inpatient abdominal, joint, or spine surgery between June 2016 and June 2019 was studied. At hospital discharge and every 7 days for 28 days, patients were assessed for pain, analgesic use, pain interference, satisfaction, and side effects. Duration of opioid use was determined for 6 months. The primary analysis used latent class group modeling to identify trajectories of opioid use.
Decreasing, high, and persistent opioid trajectories were identified following joint and spine surgery and a decreasing and persistent trajectory following abdominal surgery. Reported pain was greater in the high and persistent trajectories compared with the decreasing use trajectories. Compared with the decreasing opioid trajectory, the median duration of opioid use was increased by 4.5 (95% CI 1 to 22, p<0.01) weeks in persistent opioid use abdominal and by 6 (95% CI 0 to 6, p<0.01) weeks in the high or persistent use joint and spine groups. The odds (95% CI) of opioid use at 6 months in the high or persistent opioid use trajectory was 24.3 (2.9 to 203.4) for abdominal and 3.7 (1.9 to 7.0) for joint or spine surgery compared with the decreasing use trajectory. Morphine milliequivalent per 24 hours of hospitalization was the primary independent predictor of opioid use trajectories.
We observed distinct opioid use trajectories following abdominal and joint or spine surgery that were associated with different patterns of pain and duration of opioid use postoperatively. Prediction of postoperative opioid use trajectory groups may be clinically important for identifying risk of prolonged opioid use.
关于阿片类药物使用轨迹及其与术后疼痛和阿片类药物消耗之间关系的描述有限。我们假设，术后28天内阿片类药物的使用轨迹将与独特的疼痛模式和阿片类药物使用持续时间相关。
对2016年6月至2019年6月期间接受择期住院腹部、关节或脊柱手术的患者进行前瞻性纵向队列研究。在出院时以及出院后28天内每7天，对患者进行疼痛、镇痛药物使用、疼痛干扰、满意度和副作用评估。确定阿片类药物使用持续时间为6个月。主要分析采用潜在类别分组模型来识别阿片类药物使用轨迹。
在关节和脊柱手术后确定了阿片类药物使用量下降、高用量和持续使用的轨迹，腹部手术后确定了使用量下降和持续使用的轨迹。与使用量下降的轨迹相比，高用量和持续使用轨迹的报告疼痛程度更高。与阿片类药物使用量下降的轨迹相比，腹部手术持续使用阿片类药物时，阿片类药物使用的中位持续时间增加了4.5（95%CI 1至22，p<0.01）周，在关节和脊柱手术的高用量或持续使用组中增加了6（95%CI 0至6，p<0.01）周。与使用量下降的轨迹相比，腹部手术高用量或持续使用阿片类药物轨迹在6个月时使用阿片类药物的几率（95%CI）为24.3（2.9至203.4），关节或脊柱手术为3.7（1.9至7.0）。每24小时住院的吗啡毫克当量是阿片类药物使用轨迹的主要独立预测因素。
我们观察到腹部手术以及关节或脊柱手术后存在不同的阿片类药物使用轨迹，这些轨迹与术后不同的疼痛模式和阿片类药物使用持续时间相关。预测术后阿片类药物使用轨迹组对于识别长期使用阿片类药物的风险可能具有重要临床意义。
