Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
BMJ Open Qual. 2023 Jun;12(2). doi: 10.1136/bmjoq-2023-002278.
Spine surgery patients have high rates of perioperative opioid consumption, with a chronic opioid use prevalence of 20%. A proposed solution is the implementation of a Transitional Pain Service (TPS), which provides patient-tailored multidisciplinary care. Its feasibility has not been demonstrated in spine surgery. The main objective of this study was to evaluate the feasibility of a TPS programme in patients undergoing spine surgery.
Patients were recruited between July 2020 and November 2021 at a single, tertiary care academic centre. Success of our study was defined as: (1) enrolment: ability to enrol ≥80% of eligible patients, (2) data collection: ability to collect data for ≥80% of participants, including effectiveness measures (oral morphine equivalent (OME) and Visual Analogue Scale (VAS)-perceived analgesic management and overall health) and programme resource requirements measures (appointment attendance, 60-day return to emergency and length of stay), and (3) efficacy: estimate potential programme effectiveness defined as ≥80% of patients weaned back to their intake OME requirements at programme discharge.
Thirty out of 36 (83.3%) eligible patients were enrolled and 26 completed the TPS programme. The main programme outcomes and resource measures were successfully tracked for >80% of patients. All 26 patients had the same or lower OME at programme discharge than at intake (intake 38.75 mg vs discharge 12.50 mg; p<0.001). At TPS discharge, patients reported similar overall health VAS (pre 60.0 vs post 70.0; p=0.14), improved scores for VAS-perceived analgesic management (pre 47.6 vs post 75.6; p<0.001) and improved Brief Pain Inventory pain intensity (pre 39.1 vs post 25.0; p=0.02).
Our feasibility study successfully met or exceeded our three main objectives. Based on this success and the defined clinical need for a TPS programme, we plan to expand our TPS care model to include other surgical procedures at our centre.
脊柱手术患者围手术期阿片类药物的使用率很高，慢性阿片类药物使用率为 20%。一种可行的解决方案是实施过渡性疼痛服务（TPS），该服务提供患者定制的多学科护理。在脊柱手术中，其可行性尚未得到证实。本研究的主要目的是评估 TPS 方案在脊柱手术患者中的可行性。
患者于 2020 年 7 月至 2021 年 11 月在一家单中心、三级学术中心招募。我们研究的成功定义为：（1）入组：有能力招募≥80%的合格患者，（2）数据收集：能够收集≥80%参与者的数据，包括有效性措施（口服吗啡当量（OME）和视觉模拟量表（VAS）-感知镇痛管理和整体健康）和方案资源需求措施（预约出勤率、60 天内返回急诊和住院时间），以及（3）疗效：估计方案的潜在疗效，定义为≥80%的患者在方案出院时可逐渐减少至其 OME 需求。
36 名符合条件的患者中有 30 名（83.3%）入组，26 名完成了 TPS 方案。主要方案结果和资源措施成功地跟踪了超过 80%的患者。所有 26 名患者在 TPS 出院时的 OME 与入院时相同或更低（入院时 38.75mg 与出院时 12.50mg；p<0.001）。在 TPS 出院时，患者报告了相似的整体健康 VAS（术前 60.0 与术后 70.0；p=0.14），VAS-感知镇痛管理评分有所改善（术前 47.6 与术后 75.6；p<0.001），简明疼痛量表疼痛强度也有所改善（术前 39.1 与术后 25.0；p=0.02）。
我们的可行性研究成功地满足或超过了我们的三个主要目标。基于这一成功以及 TPS 方案的临床需求，我们计划在我们的中心将 TPS 护理模式扩展到其他手术程序。
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