Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Department of Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Int J Colorectal Dis. 2022 Aug;37(8):1799-1806. doi: 10.1007/s00384-022-04208-5. Epub 2022 Jul 7.
With increased awareness of the opioid epidemic, understanding contributing factors to postoperative opioid use is important. The purpose of this study was to evaluate patient and perioperative factors that contribute to postoperative opioid use after colorectal resections and their relation to pre-existing pain conditions and psychiatric diagnoses.
A retrospective review was conducted identifying adult patients who underwent elective colorectal resection at a single tertiary center between 2015 and 2018. Patient demographics, preoperative factors, surgical approach, and perioperative pain management were evaluated to determine standard conversion morphine milligram equivalents required for postoperative days 0 to 3 and total hospital stay.
Five hundred and ninety-two patients: 46% male, median age 58 years undergoing colorectal resections for indications including cancer, inflammatory bowel disease, and diverticulitis were identified. Less opioid use was found to be associated with female gender (β = - 42), patients who received perioperative lidocaine infusion (β = - 30), and older adults (equivalents/year) (β = - 4, all p < 0.01). Preoperative opioid use, preoperative abdominal pain, epidural use, and smoking were all independently associated with increased postoperative opioid requirements.
In this study of patients undergoing elective colorectal resection, factors that were associated with higher perioperative opioid use included male gender, smoking, younger age, preoperative opioid use, preoperative abdominal pain, and epidural use. Perioperative administration of lidocaine was associated with decreased opioid requirements. Understanding risk factors and stratifying postoperative pain regimens may aid in improved pain control and decrease long-term dependency.
随着人们对阿片类药物流行的认识不断提高，了解导致术后阿片类药物使用的因素非常重要。本研究的目的是评估与术后阿片类药物使用相关的患者和围手术期因素，及其与预先存在的疼痛状况和精神科诊断的关系。
回顾性分析了 2015 年至 2018 年期间在一家三级中心接受择期结直肠切除术的成年患者。评估患者的人口统计学数据、术前因素、手术方式和围手术期疼痛管理，以确定术后 0 至 3 天和总住院期间所需的标准转化吗啡毫克当量。
共纳入 592 例患者（46%为男性，中位年龄为 58 岁），因癌症、炎症性肠病和憩室炎等指征接受结直肠切除术。研究发现，女性（β=-42）、接受围手术期利多卡因输注（β=-30）和老年患者（等效剂量/年）（β=-4，均 P<0.01）的阿片类药物使用量较少。术前阿片类药物使用、术前腹痛、硬膜外使用和吸烟均与术后阿片类药物需求增加独立相关。
在这项对接受择期结直肠切除术的患者的研究中，与较高围手术期阿片类药物使用相关的因素包括男性、吸烟、年龄较小、术前阿片类药物使用、术前腹痛和硬膜外使用。围手术期给予利多卡因与减少阿片类药物需求相关。了解风险因素并分层术后疼痛方案可能有助于改善疼痛控制并减少长期依赖。
