Sand Addyson E, Powell Tyler E, Marry Helen T, Rathbun Heather R, Steege Jenna R, LeMahieu Allison, Jacob Adam K, D'Souza Ryan S, Olatoye Oludare O
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
J Pain Res. 2024 Oct 5;17:3267-3275. doi: 10.2147/JPR.S471160. eCollection 2024.
Patients receiving methadone, buprenorphine, and naltrexone for either chronic pain or substance use disorder (SUD) pose perioperative challenges. Due to their complex pharmacology, perioperative recommendations continue to evolve. Deviations from these recommendations may result in worse perioperative outcomes. A formal preoperative evaluation (POE) and optimization of patients on these medications are recommended to address these concerns.
A single-center retrospective electronic health record review was performed with adult patients on methadone, buprenorphine, and naltrexone undergoing elective surgery between January 1, 2010 and December 31, 2020. The primary outcome of interest was the percentage of patients referred to the POE clinic for evaluation prior to the scheduled elective surgery. In addition, we assessed differences in variables (perioperative opioid, hospital length of stay, perioperative multimodal analgesics, perioperative complications, inpatient pain service consult, readmission within 30 days, cancellation of surgery, addiction medicine consult) based on POE clinic evaluation. This analysis was performed separately for patients prescribed these medications for SUD versus chronic pain. Continuous outcomes were analyzed using linear regression with generalized estimating equations (GEE) and robust variance estimates.
A total of 714 patients were included in the final analysis, of which 572 (80%) took buprenorphine, methadone, or naltrexone for chronic pain and 142 (20%) took these medications for SUD. Within the chronic pain and SUD subpopulations, 193 (34%) and 35 (25%) patients had formal POE clinic assessments, respectively. Among those taking these medications for chronic pain, POE clinic evaluation was associated with a higher likelihood for receiving non-opioid multimodal analgesics perioperatively (p = 0.016).
Formal preoperative evaluations are currently underutilized in patients who take buprenorphine, methadone, or naltrexone for chronic pain or SUD. These patients may benefit from POE clinic assessment to optimize perioperative outcomes.
接受美沙酮、丁丙诺啡和纳曲酮治疗慢性疼痛或物质使用障碍（SUD）的患者在围手术期面临挑战。由于其复杂的药理学特性，围手术期的建议仍在不断演变。偏离这些建议可能会导致更差的围手术期结果。建议进行正式的术前评估（POE）并优化服用这些药物的患者，以解决这些问题。
对2010年1月1日至2020年12月31日期间接受美沙酮、丁丙诺啡和纳曲酮治疗并接受择期手术的成年患者进行了单中心回顾性电子健康记录审查。主要关注的结果是在预定的择期手术前被转诊至POE诊所进行评估的患者百分比。此外，我们根据POE诊所评估评估了变量（围手术期阿片类药物、住院时间、围手术期多模式镇痛药物、围手术期并发症、住院疼痛服务咨询、30天内再入院、手术取消、成瘾医学咨询）的差异。针对因SUD与慢性疼痛而服用这些药物的患者分别进行了此项分析。使用带有广义估计方程（GEE）和稳健方差估计的线性回归分析连续结果。
最终分析共纳入714例患者，其中572例（80%）因慢性疼痛服用丁丙诺啡、美沙酮或纳曲酮，142例（20%）因SUD服用这些药物。在慢性疼痛和SUD亚组中，分别有193例（34%）和35例（25%）患者进行了正式的POE诊所评估。在因慢性疼痛服用这些药物的患者中，POE诊所评估与围手术期接受非阿片类多模式镇痛药物的可能性更高相关（p = 0.016）。
目前，对于因慢性疼痛或SUD而服用丁丙诺啡、美沙酮或纳曲酮的患者，正式的术前评估未得到充分利用。这些患者可能会从POE诊所评估中受益，以优化围手术期结果。
