加巴喷丁与儿童穿孔性阑尾炎阑尾切除术后阿片类药物使用减少和住院时间缩短相关：倾向评分匹配分析。
Gabapentin is Associated With Decreased Postoperative Opioid Use and Length of Stay After Appendectomy in Children With Perforated Appendicitis: A Propensity Score-Matched Analysis.
机构信息
Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA; Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
出版信息
J Pediatr Surg. 2023 Oct;58(10):1935-1941. doi: 10.1016/j.jpedsurg.2023.03.009. Epub 2023 Mar 16.
BACKGROUND
Gabapentin is increasingly used as an off-label, opioid-sparing pain medication in children. We investigated perioperative gabapentin administration and postoperative opioid use in children who underwent appendectomy for perforated appendicitis.
METHODS
A retrospective cohort study of healthy children ages 2-18 years undergoing appendectomy for perforated appendicitis from 2014 to 2019 was performed using the Pediatric Health Information System®. Propensity score matched (PSM) analysis was conducted with 1:1 matching based on patient and hospital characteristics. Multivariable linear regression analysis was used to evaluate an association between gabapentin, postoperative opioid use, and postoperative length of stay.
RESULTS
Of 29,467 children with perforated appendicitis who underwent appendectomy, 236 (0.8%) received gabapentin. In 2014, <10 children received gabapentin, but by 2019, 110 children received gabapentin. On univariate analysis of the PSM cohort, children receiving gabapentin had decreased total postoperative opiate use (2.3 SD ± 2.3 versus 3.0 SD ± 2.5 days, p < 0.001). On adjusted analysis, children receiving gabapentin had 0.65 fewer days of postoperative total opioid use (95% CI: -1.09, -0.21) and spent 0.69 fewer days in the hospital after surgery (95% CI: -1.30, -0.08).
CONCLUSION
While overall use is infrequent, gabapentin is increasingly administered to children with perforated appendicitis who undergo an appendectomy and is associated with decreased postoperative opioid use and reduced postoperative length of stay. Multimodal pain management strategies incorporating gabapentin may reduce postoperative opioid consumption, but further studies of drug safety are needed for this off-label use in children undergoing surgery.
LEVEL OF EVIDENCE
III.
背景
加巴喷丁作为一种非标签药物，在儿童中被越来越多地用于缓解疼痛和减少阿片类药物的使用。我们调查了穿孔性阑尾炎患儿行阑尾切除术围手术期加巴喷丁的使用情况和术后阿片类药物的使用情况。
方法
使用儿科健康信息系统（Pediatric Health Information System®）对 2014 年至 2019 年期间因穿孔性阑尾炎行阑尾切除术的 2-18 岁健康儿童进行回顾性队列研究。采用 1:1 倾向评分匹配（propensity score matching，PSM）基于患者和医院特征进行匹配。采用多变量线性回归分析评估加巴喷丁与术后阿片类药物使用及术后住院时间之间的关联。
结果
在 29467 例穿孔性阑尾炎患儿中，有 236 例（0.8%）接受了加巴喷丁治疗。2014 年仅约 10 例患儿接受了加巴喷丁治疗，而到 2019 年则有 110 例患儿接受了加巴喷丁治疗。在 PSM 队列的单变量分析中，使用加巴喷丁的患儿术后总阿片类药物使用量减少（2.3 SD ± 2.3 与 3.0 SD ± 2.5 天，p < 0.001）。经调整分析，使用加巴喷丁的患儿术后总阿片类药物使用天数减少 0.65 天（95%CI：-1.09，-0.21），术后住院天数减少 0.69 天（95%CI：-1.30，-0.08）。
结论
尽管总体使用频率较低，但加巴喷丁在接受阑尾切除术的穿孔性阑尾炎患儿中的应用越来越多，与术后阿片类药物使用减少和术后住院时间缩短相关。纳入加巴喷丁的多模式疼痛管理策略可能会减少术后阿片类药物的消耗，但需要进一步研究该药在手术患儿中的安全性。
证据等级
III。
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