按需患者自控镇痛治疗镰状细胞病急性血管阻塞性疼痛。

Demand-only patient-controlled analgesia for treatment of acute vaso-occlusive pain in sickle cell disease.

机构信息

Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi.

Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.

出版信息

Pediatr Blood Cancer. 2022 Aug;69(8):e29665. doi: 10.1002/pbc.29665. Epub 2022 Mar 16.

DOI:10.1002/pbc.29665

PMID:35294090

Abstract

BACKGROUND

Sickle cell disease (SCD) is a chronic illness that is associated with frequent admissions for vaso-occlusive episodes (VOE). Opioids are frequently utilized in pain management, but dosing is often provider dependent. Opioids cause both short-term and long-term side effects, so the minimal effective dose is desired. This study examined demand-only patient-controlled analgesia (PCA) in pediatric patients.

METHODS

A new clinical practice guideline (CPG) for a single institution was implemented, which eliminated basal infusion dosing for PCAs on hospital admission. The primary aim of this retrospective study was to evaluate length of stay (LOS) before and after implementation of a CPG of demand-only PCA and, in a selected subpopulation, addition of short-term methadone. Secondary aims included opioid utilization, acute chest syndrome (ACS), and hypoxia. Inclusion criteria included SCD, ≤21 years of age, uncomplicated VOE admission, and ≥ 3 and ≤ 8 hospital admissions for SCD pain control within one calendar year.

RESULTS

LOS decreased postintervention (7.2 ± 5.1 vs 4.5 ± 3.8 days, P < 0.001). Mean total opioid utilization in morphine equivalents mg/kg markedly decreased between the cohorts (13.3 ± 33.8 vs 3.6 ± 3.0, P < 0.001). ACS (21.9% vs 2.8%, P = 0.004) and hypoxia (28% vs 6.9%, P< 0.001) decreased significantly as well.

CONCLUSION

Bolus PCA dosing of opioids resulted in decreased LOS and reductions in opioid utilization, hypoxia, and ACS.

摘要

背景

镰状细胞病（SCD）是一种慢性疾病，常因血管阻塞性发作（VOE）而频繁住院。阿片类药物常用于疼痛管理，但剂量通常取决于提供者。阿片类药物会引起短期和长期的副作用，因此需要使用最小有效剂量。本研究考察了仅按需使用患者自控镇痛（PCA）在儿科患者中的应用。

方法

一家医疗机构实施了新的临床实践指南（CPG），取消了入院时 PCA 的基础输注剂量。本回顾性研究的主要目的是评估实施 CPG 前后仅按需 PCA 的住院时间（LOS），并在选定的亚人群中，评估短期使用美沙酮的效果。次要目标包括阿片类药物的使用、急性胸部综合征（ACS）和缺氧。纳入标准包括 SCD、≤21 岁、无并发症的 VOE 入院、且在一个日历年内有≥3 次且≤8 次因 SCD 疼痛控制而住院。

结果

干预后 LOS 缩短（7.2±5.1 天 vs 4.5±3.8 天，P<0.001）。两组间吗啡等效剂量的总阿片类药物用量明显减少（13.3±33.8 毫克/公斤 vs 3.6±3.0 毫克/公斤，P<0.001）。ACS（21.9% vs 2.8%，P=0.004）和缺氧（28% vs 6.9%，P<0.001）的发生率也显著降低。