Shafeeq Hira, DiGiacomo Jody C, Sookraj Kelley A, Gerber Noam, Bahr Alaa, Talreja Om N, Munnangi Swapna, Cardozo-Stolberg Sarah, Angus L D George
Clinical Health Professions, College of Pharmacy and Health Sciences, St. John's University, Queens, New York; Department of Surgery, Nassau University Medical Center, East Meadow, New York.
Department of Surgery, Nassau University Medical Center, East Meadow, New York.
J Surg Res. 2022 Jul;275:96-102. doi: 10.1016/j.jss.2021.12.028. Epub 2022 Mar 5.
The use of intravenous (IV) acetaminophen (APAP) postoperatively in older adults may be a beneficial strategy. We implemented a multimodal pain management approach in our hospital in 2015, with IV APAP being the first-line therapy.
This was a retrospective, single-center, observational cohort study of polytrauma, orthopedic surgical patients aged ≥50 y. Patients admitted in 2017, postimplementation of pain protocol, were categorized as the exposed patients. Patients in the year 2014 served as the historical cohort. The two primary outcomes evaluated were postoperative opioid consumption in morphine milligram equivalents (MMEs) and patient pain scores.
In total, 121 eligible patients were identified for this study; 22 historical control patients and 99 exposed patients. We observed a significant reduction in postoperative opioid use up to 48 h postoperatively (20.9 ± 27 versus 4.3 ± 12.4 MME [P < 0.05] at 24 h and 19.8 ± 31.2 versus 2.1 ± 11.3 MME [P < 0.05] at 48 h, respectively). The mean opioid consumption remained significantly lower in patient subgroup of age ≥74 y with no difference in the mean pain scores (1.5 ± 1.5 versus 1.9 ± 1.6 [P = 0.48] at 24 h and 1.5 ± 1.8 versus 2.0 ± 1.5 [P = 0.21] at 48 h postoperatively in the historical versus exposed cohort, respectively). Exposed patients had a shorter hospital length of stay than control patients (5.0 [3, 7] versus 6.5 [5, 9.5] d; P = 0.01).
The use of multimodal pain management with IV APAP as first-line therapy was associated with reduced opioid use in the perioperative setting for older adults with polytrauma.
术后对老年人使用静脉注射对乙酰氨基酚（APAP）可能是一种有益的策略。2015年我们医院实施了多模式疼痛管理方法，静脉注射APAP为一线治疗方法。
这是一项对年龄≥50岁的多发伤、骨科手术患者进行的回顾性、单中心观察性队列研究。2017年疼痛方案实施后入院的患者被归类为暴露组患者。2014年的患者作为历史队列。评估的两个主要结局是术后以吗啡毫克当量（MME）计算的阿片类药物消耗量和患者疼痛评分。
本研究共纳入121例符合条件的患者；22例历史对照患者和99例暴露组患者。我们观察到术后48小时内术后阿片类药物使用量显著减少（24小时时分别为20.9±27与4.3±12.4 MME[P<0.05]，48小时时为19.8±31.2与2.1±11.3 MME[P<0.05]）。在年龄≥74岁的患者亚组中，平均阿片类药物消耗量仍显著较低，平均疼痛评分无差异（历史队列与暴露组术后24小时分别为1.5±1.5与1.9±1.6[P=0.48]，48小时时分别为1.5±1.8与2.0±1.5[P=0.21]）。暴露组患者的住院时间比对照组患者短（5.0[3,7]天与6.5[5,9.5]天；P=0.01）。
对于多发伤的老年人，在围手术期使用以静脉注射APAP为一线治疗方法的多模式疼痛管理与阿片类药物使用减少相关。
