Yue Yue, Ji Hongyan, Wang Shizhong, Cheng Huawei, Wang Rongmei, Qu Haijun, Li Jing
School of Pharmacy, Qingdao University, Qingdao, Shandong, China.
Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Curr Ther Res Clin Exp. 2024 Mar 19;100:100744. doi: 10.1016/j.curtheres.2024.100744. eCollection 2024.
Cardiovascular surgery is usually associated with higher degree of postoperative pain that influences a patient's physical recovery. Multiple clinical measures have been taken to avoid overuse of opioid agents for postoperative pain management, which led to the development of clinical pathways for analgesic drug treatment using a multimodal approach.
To evaluate the effectiveness and safety of a multimodal postoperative analgesic drug pathway (ADP) for pain management following cardiovascular surgery.
This retrospective, controlled, nonrandomized study evaluated a postoperative ADP in patients undergoing cardiovascular surgery in a tertiary general hospital in Qingdao, China. Effectiveness and safety outcomes were compared before and after the implementation of the ADP. Outcome indicators included postoperative pain scores, consumption of opioids in analgesic pumps, and incidence of adverse events.
Patients who underwent cardiovascular surgery from September to November 2021 before the implementation of the ADP (n = 193) and from September to November 2022 after the implementation of the ADP (n = 218) were enrolled. Pain scores were reduced on day 1, 3, and 5 after surgery and the reduction was most significant in mild pain ( < .001). Opioids in analgesic pumps consumption was also significantly reduced and there was decreased incidence of adverse events such as nausea and vomiting ( = .026), respiratory inhibition ( = .027), and dizziness and headache ( = .028) in cardiovascular surgery patients after implementation of the ADP.
Improved effectiveness and safety were observed following the implementation of the ADP. Multimodal analgesic ADP methodology can be effectively used for postoperative pain management in patients undergoing cardiovascular surgery.
心血管手术通常伴随着较高程度的术后疼痛，这会影响患者的身体恢复。已经采取了多种临床措施来避免在术后疼痛管理中过度使用阿片类药物，这促使了使用多模式方法的镇痛药物治疗临床路径的发展。
评估多模式术后镇痛药物路径（ADP）用于心血管手术后疼痛管理的有效性和安全性。
这项回顾性、对照、非随机研究评估了中国青岛一家三级综合医院接受心血管手术患者的术后ADP。比较了ADP实施前后的有效性和安全性结果。结果指标包括术后疼痛评分、镇痛泵中阿片类药物的消耗量以及不良事件的发生率。
纳入了在ADP实施前（2021年9月至11月，n = 193）和实施后（2022年9月至11月，n = 218）接受心血管手术患者。术后第1、3和5天的疼痛评分降低，轻度疼痛的降低最为显著（P <.001）。镇痛泵中阿片类药物的消耗量也显著减少，并且在实施ADP后，心血管手术患者恶心和呕吐（P = .026）、呼吸抑制（P = .027）以及头晕和头痛（P = .028）等不良事件的发生率降低。
实施ADP后观察到有效性和安全性得到改善。多模式镇痛ADP方法可有效用于心血管手术患者的术后疼痛管理。
