接受脊髓麻醉并鞘内注射或不注射可乐定进行剖宫产的阿片类物质使用障碍患者的镇痛效果：一项回顾性研究。
Analgesic Outcomes in Opioid Use Disorder Patients Receiving Spinal Anesthesia with or without Intrathecal Clonidine for Cesarean Delivery: A Retrospective Investigation.
作者信息
Cook Meghan I, Kushelev Michael, Coffman Julie H, Coffman John C
机构信息
Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH, USA.
出版信息
J Pain Res. 2022 Apr 21;15:1191-1201. doi: 10.2147/JPR.S358045. eCollection 2022.
BACKGROUND
Intrathecal (IT) clonidine has been observed to reduce 24-hour opioid requirements and time to first analgesic request after cesarean delivery, but has not been specifically studied in patients with opioid use disorder (OUD).
METHODS
Patients with OUD undergoing cesarean delivery under spinal or combined spinal-epidural (CSE) anesthesia at our institution from 2011 to 2020 were identified, and only patients with OUD were included in this study. Subjects that received IT clonidine were compared to a control group that did not receive IT clonidine to observe potential differences in analgesic outcomes (24-hour opioid requirements, pain scores and time to first post-operative pain medication) or side-effects (hypotension, vasopressor dosing and bradycardia).
RESULTS
A total of 160 patients were included (clonidine n = 22, controls n = 138). For the clonidine group, the median IT clonidine dose was 30µg. Clonidine group patients were observed to have greater dose of IT bupivacaine (12 vs 12.75mg; p = 0.01) and IT morphine (100 vs 200µg; p < 0.001). The clonidine group was also observed to have greater incidence of intraoperative hypotension (20% vs 45%; p = 0.01) and maximum phenylephrine dose (50 vs 57.5 µg/min; p < 0.001). The time to first analgesic request (minutes) after surgery was significantly longer for the clonidine group (153.5 vs 207 min; p < 0.001). The average oral oxycodone equivalents taken per 24 hours of hospital admission were significantly less in the clonidine group (82.36 vs 41.67mg; p < 0.001), and the clonidine group also had significantly less oxycodone equivalents taken for each post-operative day.
CONCLUSION
IT clonidine was observed to result in reduced 24-hour opioid consumption in patients with OUD and may be useful as part of a multimodal analgesic regimen. The incidence of hypotension and vasopressor doses were greater in patients receiving IT clonidine, and this should be anticipated if IT clonidine is being administered.
背景
已观察到鞘内注射可乐定可减少剖宫产术后24小时的阿片类药物需求量及首次镇痛需求时间，但尚未在阿片类药物使用障碍（OUD）患者中进行专门研究。
方法
确定2011年至2020年在本机构接受脊髓或腰麻-硬膜外联合麻醉（CSE）下行剖宫产术的OUD患者，本研究仅纳入OUD患者。将接受鞘内注射可乐定的受试者与未接受鞘内注射可乐定的对照组进行比较，以观察镇痛效果（24小时阿片类药物需求量、疼痛评分及术后首次使用止痛药物的时间）或副作用（低血压、血管升压药剂量及心动过缓）的潜在差异。
结果
共纳入160例患者（可乐定组n = 22，对照组n = 138）。可乐定组鞘内注射可乐定的中位剂量为30μg。观察到可乐定组患者鞘内注射布比卡因的剂量更大（12 vs 12.75mg；p = 0.01），鞘内注射吗啡的剂量更大（100 vs 200μg；p < 0.001）。还观察到可乐定组术中低血压的发生率更高（20% vs 45%；p = 0.01），去氧肾上腺素最大剂量更高（50 vs 57.5μg/min；p < 0.001）。可乐定组术后首次镇痛需求时间（分钟）显著更长（153.5 vs 207分钟；p < 0.001）。可乐定组入院后每24小时口服羟考酮等效剂量显著更少（82.36 vs 41.67mg；p < 0.001），且可乐定组术后每日服用的羟考酮等效剂量也显著更少。
结论
观察到鞘内注射可乐定可使OUD患者24小时阿片类药物消耗量减少，可能作为多模式镇痛方案的一部分有用。接受鞘内注射可乐定的患者低血压和血管升压药剂量的发生率更高，如果给予鞘内注射可乐定，应预料到这一点。
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