Yang Yitian, Chen Wan-Ming, Wu Szu-Yuan, Zhang Jiaqiang
Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan.
Pain Rep. 2024 Mar 8;9(2):e1129. doi: 10.1097/PR9.0000000000001129. eCollection 2024 Apr.
This study investigates the association between chronic postsurgical pain (CPSP) and long-term postsurgical analgesic usage in patients undergoing neuraxial anesthesia, with a specific focus on the presence or absence of sarcopenia.
To assess the rate of analgesic prescription, including opioids, at 3 and 6 months postsurgery for patients with and without preoperative sarcopenia, and to determine the impact of sarcopenia on analgesic use after neuraxial anesthesia surgery.
Patients undergoing surgery under neuraxial anesthesia were categorized into sarcopenic and nonsarcopenic groups based on preoperative diagnosis using the ICD-10-CM code M62.84. Propensity score matching in a 1:4 ratio was applied for group matching. Analgesic prescription rates were evaluated at 3 and 6 months postsurgery, and multivariable logistic regression was used to analyze analgesic use, comparing patients with and without preoperative sarcopenia.
Among 3805 surgical patients, 761 had sarcopenia, while 3044 did not. At 3 months postsurgery, 62.3% of sarcopenic patients received analgesics, with 2.9% receiving opioids, compared to 57.1% of nonsarcopenic patients receiving analgesics and 0.8% receiving opioids. At 6 months postsurgery, 30.8% of sarcopenic patients received analgesics (1.7% opioids), while 26.3% of non-sarcopenic patients received analgesics (0.3% opioids). Multivariable logistic regression analysis revealed that preoperative sarcopenia was significantly associated with higher analgesic prescription rates at both 3 months (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.05-1.53) and 6 months (aOR, 1.17; 95% CI, 1.07-1.42) postsurgery. Furthermore, sarcopenic patients exhibited significantly higher opioid prescription rates at 3 months (aOR, 1.11; 95% CI, 1.05-2.45) and 6 months (aOR, 1.89; 95% CI, 1.12-4.96) postsurgery.
Sarcopenia emerges as an independent risk factor for prolonged analgesic use after neuraxial anesthesia surgery and significantly elevates the risk of developing CPSP.
本研究调查接受神经轴索麻醉的患者术后慢性疼痛（CPSP）与术后长期使用镇痛药物之间的关联，特别关注肌肉减少症的存在与否。
评估术前有或无肌肉减少症患者术后3个月和6个月时包括阿片类药物在内的镇痛药物处方率，并确定肌肉减少症对神经轴索麻醉手术后镇痛药物使用的影响。
根据术前使用ICD - 10 - CM编码M62.84诊断，将接受神经轴索麻醉手术的患者分为肌肉减少症组和非肌肉减少症组。采用1:4的倾向得分匹配法进行组间匹配。评估术后3个月和6个月时的镇痛药物处方率，并使用多变量逻辑回归分析镇痛药物的使用情况，比较术前有或无肌肉减少症的患者。
在3805例手术患者中，761例有肌肉减少症，3044例没有。术后3个月时，62.3%的肌肉减少症患者接受了镇痛药物治疗，其中2.9%接受阿片类药物治疗；相比之下，57.1%的非肌肉减少症患者接受了镇痛药物治疗，0.8%接受阿片类药物治疗。术后6个月时，30.8%的肌肉减少症患者接受了镇痛药物治疗（1.7%接受阿片类药物），而26.3%的非肌肉减少症患者接受了镇痛药物治疗（0.3%接受阿片类药物）。多变量逻辑回归分析显示，术前肌肉减少症与术后3个月（调整优势比[aOR]，1.27；95%置信区间[CI]，1.05 - 1.53）和6个月（aOR，1.17；95% CI，1.07 - 1.42）时较高的镇痛药物处方率显著相关。此外，肌肉减少症患者在术后3个月（aOR，1.11；95% CI，1.05 - 2.45）和6个月（aOR，1.89；95% CI，1.12 - 4.96）时阿片类药物处方率显著更高。
肌肉减少症是神经轴索麻醉手术后镇痛药物使用时间延长的独立危险因素，并显著增加发生CPSP的风险。
