Klavansky Dana, Wanchoo Sheshali, Lin Amanda, Temes Richard E, Rebeiz Tania
Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, USA.
Department of Pharmacy and Neurocritical Care, North Shore University Hospital, Northwell Health, Manhasset, USA.
Cureus. 2021 Dec 28;13(12):e20773. doi: 10.7759/cureus.20773. eCollection 2021 Dec.
Despite multiple investigational drugs, headache due to subarachnoid hemorrhage (SAH) remains inadequately controlled and requires high opiate utilization. This study investigates the factors associated with increased opiate usage for the management of headache in SAH in the first 14 days of admission, the association between opiate usage and hospital length of stay, and the incidence of opiate consumption during the outpatient follow up. This is a single-center cross-sectional study. A total of 138 patients admitted between January 1, 2017, and May 31, 2019, with a diagnosis of SAH, were identified through a neurocritical care dashboard. Outpatient electronic medical records were evaluated at three months. Statistical analysis included descriptive statistics, Mann-Whitney U test, stepwise regression, and multiple regression analysis. We found that of 138 patients, the majority (90%) were prescribed opiates during their hospitalization, and the mean daily morphine equivalent dosage was 18.74 mg. Steroid usage was associated with an increase in 14-day opiate usage (r = 0.4, p = 0.0001); however, the cerebral spinal fluid profile did not show a statistically significant correlation. Over 14 days, smokers significantly used more opiates compared to nonsmokers (353 mg vs. 184 mg, p = 0.01). In addition, peri-mesencephalic SAH required less morphine compared to aneurysmal SAH (195 mg vs. 283 mg, p = 0.004). Aneurysm clipping was associated with less opiate usage compared to aneurysm coiling (186 vs. 320, p = 0.08). Only the high Hunt and Hess scale score predicted opiate usage, and the high modified Fisher scale score, aneurysmal SAH, and more opiate usage predicted hospital length of stay. A total of 48 patients (42%) suffered from headaches during their outpatient follow-up within three months of discharge; however, only six (5%) were still on opiates. There was a significant association between the amount of opiate used in the first 14 days of admission and the rate of post-discharge headache. In summary, even though patients admitted with SAH require a large amount of opiate for headache management, this did not lead to more opiate consumption in the outpatient setting. However, patients continued to suffer from headaches at three months follow-up. This high opiate consumption is associated with increased hospital length of stay. Studies are needed to identify opiate sparing analgesics that target the pathogenesis of headaches in this patient population.
尽管有多种研究性药物，但蛛网膜下腔出血（SAH）所致头痛仍未得到充分控制，且需要大量使用阿片类药物。本研究调查了入院后前14天SAH头痛管理中阿片类药物使用增加的相关因素、阿片类药物使用与住院时间的关联以及门诊随访期间阿片类药物消费的发生率。这是一项单中心横断面研究。通过神经重症监护仪表板识别出2017年1月1日至2019年5月31日期间共138例诊断为SAH的住院患者。在三个月时对门诊电子病历进行评估。统计分析包括描述性统计、曼-惠特尼U检验、逐步回归和多元回归分析。我们发现，138例患者中，大多数（90%）在住院期间使用了阿片类药物，平均每日吗啡当量剂量为18.74毫克。使用类固醇与14天阿片类药物使用增加相关（r = 0.4，p = 0.0001）；然而，脑脊液检查结果未显示出统计学上的显著相关性。在14天内，吸烟者比不吸烟者显著使用更多阿片类药物（353毫克对184毫克，p = 0.01）。此外，中脑周围型SAH比动脉瘤性SAH需要更少的吗啡（195毫克对283毫克，p = 0.004）。与动脉瘤栓塞术相比，动脉瘤夹闭术与较少的阿片类药物使用相关（186对320，p = 0.08）。只有高Hunt和Hess分级评分可预测阿片类药物使用，而高改良Fisher分级评分、动脉瘤性SAH和更多的阿片类药物使用可预测住院时间。共有48例患者（42%）在出院后三个月的门诊随访期间出现头痛；然而，只有6例（5%）仍在使用阿片类药物。入院后前14天使用的阿片类药物量与出院后头痛发生率之间存在显著关联。总之，尽管SAH患者因头痛管理需要大量阿片类药物，但这并未导致门诊环境中更多的阿片类药物消费。然而，患者在三个月随访时仍持续头痛。这种高阿片类药物消费量与住院时间延长相关。需要开展研究以确定针对该患者群体头痛发病机制的阿片类药物节省型镇痛药。
