Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland; Division of Anesthesiology, Spectrum Healthcare Partners, South Portland, Maine; Tufts University School of Medicine, Boston, Massachusetts. ORCID: https://orcid.org/0000-0002-7573-2164.
University of New England College of Osteopathic Medicine, Portland, Maine.
J Opioid Manag. 2024 May-Jun;20(3):233-241. doi: 10.5055/jom.0823.
This study aimed to determine whether there is a difference in pain scores and opioid consumption after elective surgery in patients maintained on methadone or buprenorphine for opioid use disorder (OUD). Additionally, we investigated the impact of continuing or discontinuing methadone or buprenorphine on post-operative pain outcomes.
A single-center retrospective cohort study.
Tertiary care medical center.
Adults aged 18 years or older with OUD maintained on buprenorphine or methadone who underwent elective surgery between January 1, 2017, and January 1, 2021.
Patients were identified through electronic medical records, and demographic and clinical data were collected.
The primary outcome was opioid consumption at 24 hours post-operatively, measured in milligram morphine equivalents. The secondary outcome was opioid consumption and pain scores up to 72 hours post-operatively, assessed using a numeric rating scale.
This study included 366 patients (64 percent on buprenorphine and 36 percent on methadone). Opioid utilization significantly increased when buprenorphine was not administered post-operatively. Both groups exhibited comparable total opioid consumption during the post-operative period. In the buprenorphine cohort, pain scores differed significantly based on the receipt of medications for OUD post-operatively.
This study reinforces existing evidence supporting the continuation of medications for opioid use disorder, specifically buprenorphine and methadone, during the perioperative period. Dissemination of guideline recommendations is essential to ensure optimal post-operative pain management for this patient population.
本研究旨在确定在接受阿片类药物使用障碍（OUD）治疗的患者中，维持使用美沙酮或丁丙诺啡后，择期手术的疼痛评分和阿片类药物消耗是否存在差异。此外，我们还研究了继续或停止使用美沙酮或丁丙诺啡对术后疼痛结果的影响。
单中心回顾性队列研究。
三级保健医疗中心。
18 岁或以上患有 OUD 并接受丁丙诺啡或美沙酮维持治疗的成年人，这些患者在 2017 年 1 月 1 日至 2021 年 1 月 1 日期间接受了择期手术。
通过电子病历识别患者，并收集人口统计学和临床数据。
主要结局是术后 24 小时内的阿片类药物消耗，以毫克吗啡当量计量。次要结局是术后 72 小时内的阿片类药物消耗和疼痛评分，使用数字评分量表评估。
本研究纳入了 366 名患者（64%使用丁丙诺啡，36%使用美沙酮）。当术后不给予丁丙诺啡时，阿片类药物的使用显著增加。两组在术后期间的总阿片类药物消耗相当。在丁丙诺啡组中，术后是否接受 OUD 治疗药物对疼痛评分有显著影响。
本研究强化了现有证据，支持在围手术期继续使用阿片类药物使用障碍药物，特别是丁丙诺啡和美沙酮。传播指南建议对于这一患者群体的术后疼痛管理至关重要。
