全麻下紧急剖宫产多模式阿片类药物节约性疼痛管理：一项质量改进项目。
Multimodal opioid-sparing pain management for emergent cesarean delivery under general anesthesia: a quality improvement project.
机构信息
Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9068, USA.
Department of Obstetrics and Gynecology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9159, USA.
出版信息
BMC Anesthesiol. 2022 Jul 27;22(1):239. doi: 10.1186/s12871-022-01780-9.
BACKGROUND
Opioid-sparing multimodal analgesic approach has been shown to provide effective postoperative pain relief and reduce postoperative opioid consumption and opioid-associated adverse effects. While many studies have evaluated analgesic strategies for elective cesarean delivery, few studies have investigated analgesic approaches in emergent cesarean deliveries under general anesthesia. The primary aim of this quality improvement project is to evaluate opioid consumption with the use of a multimodal opioid-sparing pain management pathway in patients undergoing emergent cesarean delivery under general anesthesia.
METHODS
Seventy-two women (age > 16 years) undergoing emergent cesarean delivery under general anesthesia before (n = 36) and after (n = 36) implementation of a multimodal opioid-sparing pain management pathway were included. All patients received a standardized general anesthetic. Prior to implementation of the pathway, postoperative pain management was primarily limited to intravenous patient-controlled opioid administration. The new multimodal pathway included scheduled acetaminophen and non-steroidal anti-inflammatory medications and ultrasound-guided classic lateral transversus abdominis plane blocks with postoperative opioids reserved only for rescue analgesia. Data obtained from electronic records included demographics, intraoperative opioid use, and pain scores and opioid consumption upon arrival to the recovery room, at 2, 6, 12, 24, 48, and 72 h postoperatively.
RESULTS
Patients receiving multimodal opioid sparing analgesia (AFTER group) had lower opioid use for 72 h, postoperatively. Only 2 of the 36 patients (5.6%) in the AFTER group required intravenous opioids through patient-controlled analgesia while 30 out of 36 patients (83.3%) in the BEFORE group required intravenous opioids.
CONCLUSIONS
Multimodal opioid-sparing analgesia is associated with reduced postoperative opioid consumption after emergent cesarean delivery.
背景
已证明，阿片类药物节约型多模式镇痛方法可有效缓解术后疼痛，并减少术后阿片类药物的消耗和阿片类药物相关的不良反应。虽然许多研究评估了选择性剖宫产的镇痛策略，但很少有研究调查全身麻醉下紧急剖宫产的镇痛方法。本质量改进项目的主要目的是评估在全身麻醉下进行紧急剖宫产时使用多模式阿片类药物节约型疼痛管理途径的阿片类药物消耗。
方法
共纳入 72 名（年龄＞16 岁）在全身麻醉下接受紧急剖宫产的女性，分别在实施多模式阿片类药物节约型疼痛管理途径前（n=36）和后（n=36）进行。所有患者均接受标准全身麻醉。在实施该途径之前，术后疼痛管理主要限于静脉患者自控阿片类药物给药。新的多模式途径包括计划给予对乙酰氨基酚和非甾体抗炎药，以及超声引导下经典外侧腹横肌平面阻滞，仅在术后镇痛时保留阿片类药物。从电子病历中获取的数据包括人口统计学资料、术中阿片类药物使用以及到达恢复室时、术后 2、6、12、24、48 和 72 小时的疼痛评分和阿片类药物消耗。
结果
接受多模式阿片类药物节约型镇痛的患者（AFTER 组）术后 72 小时内的阿片类药物使用量较低。在 AFTER 组的 36 名患者中，只有 2 名（5.6%）需要通过患者自控镇痛给予静脉阿片类药物，而在 BEFORE 组的 36 名患者中，有 30 名（83.3%）需要静脉阿片类药物。
结论
多模式阿片类药物节约型镇痛与紧急剖宫产术后阿片类药物消耗减少相关。
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