心脏手术后术中使用美沙酮对术后阿片类药物需求的影响。

Impact of intraoperative methadone use on postoperative opioid requirements after cardiac surgery.

机构信息

Department of Pharmacy, Boston Medical Center, Boston, MA, USA.

Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USA.

出版信息

Am J Health Syst Pharm. 2022 Apr 1;79(8):636-642. doi: 10.1093/ajhp/zxab459.

DOI:10.1093/ajhp/zxab459

PMID:34874991

Abstract

PURPOSE

Inadequate pain control after cardiac surgery increases postoperative morbidity. Increasing evidence suggests that perioperative intravenous (IV) methadone results in improved analgesia. This study evaluated the effect of intraoperative IV methadone on postoperative opioid requirements and surgical recovery.

METHODS

A retrospective review of patients undergoing coronary artery bypass graft (CABG), valvular surgery or both between April 2017 and August 2018 was conducted. Patients were separated into a usual care cohort of those who received short-acting opioids (ie, IV fentanyl, hydromorphone, or morphine) alone or a methadone cohort of those who received IV methadone plus short-acting opioids. Opioid requirements were assessed within the first 24 hours of surgery (postoperative day [POD] 0) and 25 to 48 hours after surgery (POD 1) as oral morphine milligram equivalents (MME). Postoperative pain scores, adjunctive analgesia, time to extubation, use of noninvasive respiratory support (continuous positive airway pressure [CPAP] or bilevel positive airway pressure [BiPAP]), and intensive care unit (ICU) and hospital length of stay (LOS) were also evaluated.

RESULTS

A total of 117 patients were evaluated (methadone cohort, n = 52; usual care cohort, n = 65). Median cumulative intraoperative opioid consumption was less in the methadone cohort (150 MME vs 314.1 MME; P < 0.0001). The methadone cohort required 44% fewer MME than the usual care cohort on POD 0 (median MME, 15.8 vs 36; P = 0.025), with low and not significantly different opioid use in both cohorts on POD 1 (15.5 MME vs 7.5 MME; P = 0.47). Weight-based methadone dosing ranged from 0.1 to 0.4 mg/kg (mean, 0.22 mg/kg). There were no significant differences in pain scores, time to extubation, use of CPAP or BiPAP, or ICU and hospital LOS.

CONCLUSION

Intraoperative IV methadone in cardiac surgery patients was safe and significantly reduced intraoperative and postoperative opioid requirements on POD 0.

摘要

目的

心脏手术后疼痛控制不足会增加术后发病率。越来越多的证据表明，围手术期静脉（IV）美沙酮可改善镇痛效果。本研究评估了术中 IV 美沙酮对术后阿片类药物需求和手术恢复的影响。

方法

对 2017 年 4 月至 2018 年 8 月期间接受冠状动脉旁路移植术（CABG）、瓣膜手术或两者联合治疗的患者进行回顾性分析。患者分为接受短效阿片类药物（即 IV 芬太尼、氢吗啡酮或吗啡）单独治疗的常规护理组或接受 IV 美沙酮联合短效阿片类药物治疗的美沙酮组。术后 24 小时内（术后第 0 天（POD））和术后 25 至 48 小时（POD 1）评估阿片类药物需求，以口服吗啡毫克当量（MME）表示。还评估了术后疼痛评分、辅助镇痛、拔管时间、无创呼吸支持（持续气道正压通气（CPAP）或双相气道正压通气（BiPAP））的使用以及重症监护病房（ICU）和住院时间（LOS）。

结果

共评估了 117 例患者（美沙酮组，n = 52；常规护理组，n = 65）。美沙酮组术中累积阿片类药物消耗量明显低于常规护理组（150 MME 比 314.1 MME；P < 0.0001）。美沙酮组在 POD 0 时需要的 MME 比常规护理组少 44%（中位数 MME，15.8 比 36；P = 0.025），而两组在 POD 1 时阿片类药物的使用量均较低且无显著差异（15.5 MME 比 7.5 MME；P = 0.47）。基于体重的美沙酮剂量范围为 0.1 至 0.4 毫克/千克（平均 0.22 毫克/千克）。两组在疼痛评分、拔管时间、CPAP 或 BiPAP 的使用以及 ICU 和住院 LOS 方面均无显著差异。