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在郊区医院环境中,多次单次外周神经阻滞对术后短期阿片类药物使用及临床结局的镇痛效果

Analgesic Efficacy of Multiple Single-Shot Peripheral Nerve Blocks on Postoperative Short-Term Opioid Usage and Clinical Outcomes in a Suburban Hospital Setting.

作者信息

Soler James, Sciortino Ned, Badaglialacqua Sara, Ryan Craig, Marchand Greg

机构信息

University of Arizona College of Nursing, Tucson, AZ, USA.

Midwestern School of Osteopathic Medicine, Glendale, AZ, USA.

出版信息

J Clin Med Res. 2022 Jun;14(6):219-228. doi: 10.14740/jocmr4731. Epub 2022 Jun 27.

Abstract

BACKGROUND

Preoperative single-shot peripheral nerve blocks (sPNBs) represent promising candidates for controlling postoperative pain, reducing dependence on opioid medications, and reducing postoperative constipation and ileus. However, there is not yet complete consensus regarding their efficacy. The primary aim of this study was to assess the impact of various sPNBs on patient short-term opioid demands and pain management parameters.

METHODS

This single-center study retrospectively reviewed a cohort of 94 adult, elective surgery inpatients (ASA physical status I-III) scheduled for different operations. Sixty-four (68.1%) were selected for sPNB administration (group 1) and compared to the untreated group (group 0) for different clinical parameters.

RESULTS

Contrary to the starting hypothesis, a higher proportion of group 1 patients experienced increasing pain intensities during the immediate postoperative period (P < 0.05, Fisher's exact test), while requiring more bowel care medications (P < 0.05, χ test). Multiple linear regression modeling, however, showed that recovery time positively correlated with the opioid amount consumed (P < 0.01). Although limited, the results obtained in this study do not support an analgesic efficacy for sPNBs.

CONCLUSION

In conclusion, even though our data must be viewed within the limitations of our retrospective study and small group size, we did not find any compelling evidence for the efficacy of sPNB administration in the perioperative period.

摘要

背景

术前单次外周神经阻滞(sPNB)有望用于控制术后疼痛、减少对阿片类药物的依赖以及减少术后便秘和肠梗阻。然而,关于其疗效尚未达成完全共识。本研究的主要目的是评估各种sPNB对患者短期阿片类药物需求和疼痛管理参数的影响。

方法

这项单中心研究回顾性分析了一组计划进行不同手术的94例成年择期手术住院患者(ASA身体状况I-III级)。64例(68.1%)患者接受sPNB给药(第1组),并与未治疗组(第0组)比较不同临床参数。

结果

与初始假设相反,第1组中更高比例的患者在术后即刻疼痛强度增加(P<0.05,Fisher精确检验),同时需要更多的肠道护理药物(P<0.05,χ检验)。然而,多元线性回归模型显示恢复时间与阿片类药物消耗量呈正相关(P<0.01)。尽管本研究结果有限,但并不支持sPNB具有镇痛效果。

结论

总之,尽管我们的数据必须在回顾性研究和小样本量的局限性内看待,但我们未发现任何令人信服的证据表明围手术期给予sPNB有效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9ec1/9275436/04072b1890c2/jocmr-14-219-g001.jpg

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