Preoperative Multimodal Analgesia Decreases Postanesthesia Care Unit Narcotic Use and Pain Scores in Outpatient Breast Surgery
Preoperative Multimodal Analgesia Decreases Postanesthesia Care Unit Narcotic Use and Pain Scores in Outpatient Breast Surgery
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DOI：
10.1097/prs.0000000000004804
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发表时间：
2018-10-01
影响因子：
3.6
通讯作者：
Janis, Jeffrey E.
中科院分区：
文献类型：
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作者：
Barker, Jenny C.;DiBartola, Kaitlin;Janis, Jeffrey E.
背景：阿片类药物的流行需要围手术期疼痛管理的改变。 2015 年，因阿片类药物过量导致 33,000 例死亡，其中一半人服用处方阿片类药物。多模式镇痛是一种改变实践的演变，可减少对阿片类药物的依赖。门诊乳房手术是实施这些策略的理想机会。方法：对 560 名接受门诊乳房手术的患者进行回顾性分析。患者 (1) 未接受术前镇痛 (n = 333)； (2) 术中静脉注射对乙酰氨基酚（n = 78）； (3)术前口服对乙酰氨基酚和加巴喷丁(n=95)； (4) 术前口服对乙酰氨基酚、加巴喷丁和塞来昔布 (n = 54)。结果包括麻醉后监护室麻醉剂的使用、疼痛评分、麻醉后监护室住院时间、抢救止吐药的使用和 30 天并发症。 结果：两种口服多模式镇痛方案均显着减少麻醉后监护室麻醉剂的使用（口服对乙酰氨基酚和加巴喷丁，14.3 +/- 1.7；口服加巴喷丁、对乙酰氨基酚和塞来昔布， 11.9 +/- 2.2；与无药物相比，19.2 +/- 1.1 mg 口服吗啡当量；p = 0.0006），初始疼痛评分（口服对乙酰氨基酚和加巴喷丁，3.9 +/- 0.4；口服加巴喷丁、对乙酰氨基酚和塞来昔布，3.4 +/- 0.7；与无药物相比，5.3 +/- 0.3 1 至 10 等级，p = 0.0002）和最大疼痛评分（口服对乙酰氨基酚和加巴喷丁，4.3 +/- 0.4；口服加巴喷丁、对乙酰氨基酚和塞来昔布，3.6 +/- 0.7；与不使用药物相比，1 至 10 等级为 5.9 +/- 0.3；p < 0.0001）。在控制年龄、体重指数、美国麻醉医师协会等级、手术时间、先前麻醉处方可用性和术中局部麻醉剂后，两种口服方案均优于不服用药物或单独静脉注射对乙酰氨基酚的多变量模型。麻醉后监护室的住院时间、止吐剂的使用和 30 天并发症没有差异。结论：术前口服多模式镇痛可减少门诊乳房整形手术中麻醉剂的使用和疼痛评分。这些方案价格低廉，可改善疼痛控制，并有助于在全国阿片类药物流行的情况下节省麻醉剂的临床实践。临床问题/证据水平：治疗，III。
Background: The opioid epidemic demands changes in perioperative pain management. Of the 33,000 deaths attributable to opioid overdose in 2015, half received prescription opioids. Multimodal analgesia is a practice-altering evolution that reduces reliance on opioid medications. Ambulatory breast surgery is an ideal opportunity to implement these strategies.Methods: A retrospective review of 560 patients undergoing outpatient breast procedures was conducted. Patients received (1) no preoperative analgesia (n = 333); (2) intraoperative intravenous acetaminophen (n = 78); (3) preoperative oral acetaminophen and gabapentin (n = 95); or (4) preoperative oral acetaminophen, gabapentin and celecoxib (n = 54). Outcomes included postanesthesia care unit narcotic use, pain scores, postanesthesia care unit length of stay, rescue antiemetic use, and 30-day complications.Results: Both oral multimodal analgesia regimens significantly reduced postanesthesia care unit narcotic use (oral acetaminophen and gabapentin, 14.3 +/- 1.7; oral gabapentin, acetaminophen, and celecoxib, 11.9 +/- 2.2; versus no drug, 19.2 +/- 1.1 mg oral morphine equivalents; p = 0.0006), initial pain scores (oral acetaminophen and gabapentin, 3.9 +/- 0.4; oral gabapentin, acetaminophen, and celecoxib, 3.4 +/- 0.7; versus no drug, 5.3 +/- 0.3 on a 1 to 10 scale, p = 0.0002) and maximum pain scores (oral acetaminophen and gabapentin, 4.3 +/- 0.4; oral gabapentin, acetaminophen, and celecoxib, 3.6 +/- 0.7; versus no drug, 5.9 +/- 0.3 on a 1 to 10 scale; p < 0.0001). Both oral regimens were better than no medications or intravenous acetaminophen alone in multivariate models after controlling for age, body mass index, American Society of Anesthesiologists class, length of surgery, prior narcotic prescription availability, and intraoperative local anesthetic. Postanesthesia care unit length of stay, antiemetic use, and 30-day complications were not different.Conclusions: Preoperative oral multimodal analgesia reduces narcotic use and pain scores in outpatient breast plastic surgery. These regimens are inexpensive, improve pain control, and contribute to narcotic-sparing clinical practice in the setting of a national opioid epidemic.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.