Meineke Minhthy N, Losli Matthew V, Sztain Jacklynn F, Swisher Matthew W, Abramson Wendy B, Martin Erin I, Furnish Timothy J, Salmasi Amirali, Derweesh Ithaar H, Gabriel Rodney A, Said Engy T
Division of Acute Pain, Department of Anesthesiology, University of California, 9400 Campus Point Dr, San Diego, La Jolla, CA, 92037, USA.
Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA.
World J Urol. 2024 Mar 4;42(1):117. doi: 10.1007/s00345-024-04801-z.
The objective of this study was to perform a retrospective cohort analysis, in which we measured the association of an acute pain service (APS)-driven multimodal analgesia protocol that included preoperative intrathecal morphine (ITM) compared to historic controls (i.e., surgeon-driven analgesia protocol without ITM) with postoperative opioid use.
This was a retrospective cohort study in which the primary objective was to determine whether there was a decrease in median 24-h opioid consumption (intravenous morphine equivalents [MEQ]) among robotic nephrectomy patients whose pain was managed by the surgical team prior to the APS, versus pain managed by APS. Secondary outcomes included opioid consumption during the 24-48 h and 48-72 h period and hospital length of stay. To create matched cohorts, we performed 1:1 (APS:non-APS) propensity score matching. Due to the cohorts occurring at the different time periods, we performed a segmented regression analysis of an interrupted time series.
There were 76 patients in the propensity-matched cohorts, in which 38 (50.0%) were in the APS cohort. The median difference in 24-h opioid consumption in the pre-APS versus APS cohort was 23.0 mg [95% CI 15.0, 31.0] (p < 0.0001), in favor of APS. There were no differences in the secondary outcomes. On segmented regression, there was a statistically significant drop in 24-h opioid consumption in the APS cohort versus pre-APS cohort (p = 0.005).
The implementation of an APS-driven multimodal analgesia protocol with ITM demonstrated a beneficial association with postoperative 24-h opioid consumption following robot-assisted nephrectomy.
本研究的目的是进行一项回顾性队列分析，在该分析中，我们测量了一种由急性疼痛服务（APS）驱动的多模式镇痛方案（包括术前鞘内注射吗啡（ITM））与历史对照（即由外科医生驱动的无ITM的镇痛方案）相比与术后阿片类药物使用之间的关联。
这是一项回顾性队列研究，其主要目的是确定在APS之前由手术团队管理疼痛的机器人肾切除术患者与由APS管理疼痛的患者相比，24小时阿片类药物消费量中位数（静脉注射吗啡当量[MEQ]）是否有所下降。次要结局包括24 - 48小时和48 - 72小时期间的阿片类药物消费量以及住院时间。为了创建匹配队列，我们进行了1:1（APS:非APS）倾向评分匹配。由于队列发生在不同时间段，我们对中断时间序列进行了分段回归分析。
倾向评分匹配队列中有76例患者，其中38例（50.0%）在APS队列中。APS前队列与APS队列中24小时阿片类药物消费量的中位数差异为23.0毫克[95%CI 15.0, 31.0]（p < 0.0001），有利于APS。次要结局无差异。在分段回归中，APS队列与APS前队列相比，24小时阿片类药物消费量有统计学显著下降（p = 0.005）。
实施包含ITM的APS驱动的多模式镇痛方案与机器人辅助肾切除术后24小时阿片类药物消费呈有益关联。
