Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
J Cardiothorac Vasc Anesth. 2023 Jul;37(7):1179-1187. doi: 10.1053/j.jvca.2023.03.001. Epub 2023 Mar 10.
To compare the outcomes of 2 multimodal analgesic regimens with an opioid-based one.
A 2-stage, retrospective study.
A large tertiary-care facility.
Adult cardiac surgical patients.
Patients received one of three regimens: opioid-only or 2 multimodal regimens. The opioid regimen included intraoperative fentanyl and patient-controlled analgesia pumps. Multimodal regimen 1 included preoperative extended-release oxycodone, intraoperative ketamine infusion, and postoperative morphine suppository. Multimodal regimen 2 included intraoperative methadone and dexmedetomidine infusion.
Outcomes measured included opioid use, pain scores, time to tracheal extubation, postoperative antiemetic use as a surrogate marker for postoperative nausea and vomiting (PONV), age, sex, surgical procedure(s), body mass index, time to first bowel movement, intensive care unit length of stay (LOS), and hospital LOS. Intraoperative median oral morphine equivalents (OMEs) declined from 425 mg (314, 518) to 150 mg (75, 150) and 230 mg (160, 240), p < 0.001, in multimodal regimens 1 and 2, respectively, compared with the opioid-only regimen. Predischarge opioid use was reduced from a median OME of 7.5 mg (0, 22.5) to 5 mg (0, 22.5) and 0 mg (0, 15.0), p < 0.001, in multimodal regimens 1 and 2, respectively. Pain scores were reduced in the multimodal regimen 2 for hours 0 to 6 (estimated difference = -1.5, 95% CI -1.8 to -1.2, p < 0.001) compared with the opioid-only regimen. The PONV treatment was reduced in multimodal regimen 1 versus the opioid-based or multimodal regimen 2 (53% v 64% and 62%), and time to tracheal extubation was clinically equivalent across all regimens: 4.2 (2.8, 6.0), 3.6 (2.3, 5.7), and (3.0, 6.2) hours for the opioid and multimodal regimens 1 and 2, respectively.
Multimodal analgesic regimens, particularly when incorporating methadone and dexmedetomidine, significantly reduced total and predischarge opioid use in cardiac surgical patients.
比较两种多模式镇痛方案与阿片类药物为基础的方案的结果。
两阶段回顾性研究。
一家大型三级保健机构。
成人心脏外科患者。
患者接受三种方案之一：阿片类药物单一方案或两种多模式方案。阿片类药物方案包括术中芬太尼和患者自控镇痛泵。多模式方案 1 包括术前口服缓释羟考酮、术中氯胺酮输注和术后吗啡栓剂。多模式方案 2 包括术中使用美沙酮和右美托咪定输注。
测量的结果包括阿片类药物使用、疼痛评分、气管拔管时间、术后止吐药使用作为术后恶心和呕吐（PONV）的替代标志物、年龄、性别、手术程序、体重指数、首次排便时间、重症监护病房住院时间（LOS）和住院 LOS。与阿片类药物单一方案相比，多模式方案 1 和 2 术中中位数口服吗啡等效物（OME）分别从 425mg（314，518）下降至 150mg（75，150）和 230mg（160，240），p<0.001。多模式方案 1 和 2 分别与阿片类药物单一方案相比，出院前 OME 用量从 7.5mg（0，22.5）降至 5mg（0，22.5）和 0mg（0，15.0），p<0.001。多模式方案 2 在 0 至 6 小时时疼痛评分降低（估计差异=-1.5，95%置信区间-1.8 至-1.2，p<0.001）与阿片类药物单一方案相比。与阿片类药物为基础方案或多模式方案 2（53%比 64%和 62%）相比，多模式方案 1 中的 PONV 治疗减少，气管拔管时间在所有方案中均具有临床等效性：阿片类药物和多模式方案 1 和 2 分别为 4.2（2.8，6.0）、3.6（2.3，5.7）和（3.0，6.2）小时。
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