Association between intra-operative fentanyl dosing and postoperative nausea/vomiting and pain A prospective cohort study
Association between intra-operative fentanyl dosing and postoperative nausea/vomiting and pain A prospective cohort study
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DOI：
10.1097/eja.0000000000001081
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发表时间：
2019-11-01
影响因子：
3.6
通讯作者：
Bandschapp, Oliver
中科院分区：
文献类型：
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作者：
Mauermann, Eckhard;Clamer, Damian;Bandschapp, Oliver
背景术后恶心和/或呕吐(PONV)是患者最害怕的麻醉相关反应之一，可能会延误出院时间。虽然评分和危险因素已经确定，但许多都是在当代麻醉方案之前发展起来的，并且没有关注可修改的麻醉相关变量。目的检查术中芬太尼剂量与PONV之间是否存在关联，以及第二，术后24小时内的疼痛是否存在关联。设计前瞻性观察队列。设置单中心大学医院。PATIENTS纳入标准是没有慢性疼痛且简化Apfel评分至少为2分的阿片类药物治疗患者，接受腹部、妇科或耳鼻喉科手术。非手术治疗非Logistic预后我们研究了三种复杂性增加的模型，以探索PONV和芬太尼剂量之间的关系：模型1，简化的Apfel评分+术中芬太尼；模型2，模型1+预防性止吐；模型3，模型2+术后吗啡。模型1为主要分析方法。结果在363例患者中，163例(45%)出现了PONV，尽管80%以上的患者使用了异丙酚全凭静脉麻醉，约66%的患者接受了额外的止吐药物。在调整简化的Apfel评分后，术中芬太尼剂量较高与PONV：优势比每微克小时(-1)、1.006[95%可信区间(CI)1.002至1.010]相关。包括术中芬太尼在内的简化Apfel评分也增加了接受者操作员特征曲线下的面积[0.601(95%CI 0.555至0.662)vs 0.651(95%CI 0.594至0.707)；P=0.016]。术中芬太尼剂量越大，24 h疼痛评分越高(P=0.001)，24 h吗啡用量越高(P=0.055)。结论即使在使用异丙酚和止吐药物的情况下，术后24 h内的负荷量仍高于预期。术中芬太尼是一种可改变的危险因素，与PONV和术后疼痛的发生率有关。
BACKGROUND Postoperative nausea and/or vomiting (PONV) is one of the anaesthesia-related effects most dreaded by patients and may delay hospital discharge. Although scores and risk factors are established, many were developed before contemporary anaesthesia regimens and without focussing on modifiable anaesthesia-related variables.OBJECTIVE To examine whether, in association with a contemporary anaesthesia regimen, there is an association between intra-operative fentanyl dose and PONV, and, second, postoperative pain within the first 24 h.DESIGN Prospective, observational cohort.SETTING Single-centre university hospital.PATIENTS Inclusion criteria were opioid-naive patients without chronic pain and with a simplified Apfel score at least 2 undergoing abdominal, gynaecological or otorhinolaryngological inpatient surgery.INTERVENTION None.MAIN OUTCOME MEASURE With logistic regression, we examined three models of increasing complexity exploring the relationship between PONV and fentanyl dosing: Model 1, simplified Apfel score + intra-operative fentanyl; Model 2, Model 1 + pre-emptive antiemetic prophylaxis; Model 3, Model 2 + postoperative morphine. Model 1 was the primary analysis. Second, we explored whether or not postoperative pain scores were associated with intra-operative fentanyl dosing.RESULTS From the 363 patients, 163 (45%) experienced PONV, despite the use of total intravenous anaesthesia with propofol in more than 80% of the cohort, and some 66% of patients receiving additional antiemetic agents. After adjusting for the simplified Apfel score, higher intra-operative fentanyl dose was associated with PONV: odds ratio per mu g h(-1), 1.006 [95% confidence interval (CI) 1.002 to 1.010]. Including intra-operative fentanyl in the simplified Apfel score also increased the area under the receiver operator characteristics curve [0.601 (95% CI 0.555 to 0.662) vs. 0.651 (95% CI 0.594 to 0.707); P = 0.016]. Finally, a higher intra-operative fentanyl dose was associated with higher 24 h pain scores (P = 0.001) and a trend towards higher 24 h morphine requirements (P = 0.055).CONCLUSION Even when using propofol and antiemetic agents, PONV within the first 24 h remained higher than expected. Intra-operative fentanyl, a modifiable risk factor, is associated with the incidence of PONV and postoperative pain.