The association of postoperative dexmedetomidine with pain, opiate utilization, and hospital length of stay in children post-Chiari malformation decompression.
The association of postoperative dexmedetomidine with pain, opiate utilization, and hospital length of stay in children post-Chiari malformation decompression.
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DOI：
10.3171/2021.10.peds21291
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发表时间：
2022-03-01
影响因子：
1.9
通讯作者：
Rowan, Courtney M.
中科院分区：
文献类型：
--
作者：
Cater, Daniel T.;Rogerson, Colin M.;Hobson, Michael J.;Ackerman, Laurie L.;Rowan, Courtney M.
关键词：
本研究的目的是确定在接受Chiari畸形减压术的儿童中，术后右旋美托咪定与疼痛标志的相关性。我们假设术后接受右美托咪定治疗的患者将减少阿片类药物的累积使用量。我们进一步假设在中位疼痛评分、结果或药物不良事件方面不会有差异。对2015年12月1日至2018年12月31日期间接受Chiari畸形减压术的患者进行了IRB批准的回顾性队列研究。纳入在我所接受Chiari畸形硬膜内减压术的患者，年龄0-21岁。对术后使用右旋美托咪定的患者和未使用右旋美托咪定的患者的数据进行比较。我们的主要结果是在住院期间累积使用阿片类药物。次要结果包括疼痛评分、辅助药物使用、不良事件、住院时间、再住院率和住院费用。我们回顾了172例接受Chiari畸形减压术的患者。在这些患者中，86名患者术后接受了右美托咪定治疗，86名患者没有接受治疗。这两组人的人口统计数据没有什么不同。术后接受右美托咪定治疗的患者接受更多剂量的地塞米松，术中更频繁地暴露于右美托咪定(p=0.028)。术后接受右美托咪定治疗的患者在入院期间使用的吗啡当量较少(1.01 mg/kg比1.43 mg/kg，p=0.003)。术后接受右美托咪定治疗的患者在术后第0天的中位疼痛评分也较低(0比2，p<；0.001)，整个入院期间的中位疼痛评分较低(1比2，p<；0.001)，最大疼痛评分也较低(6比8，p=0.005)。调整类固醇剂量和术中右美托咪定暴露，术后右美托咪定仍然与较低的阿片类药物剂量、较低的POD零时疼痛评分、较低的住院期间评分和较低的最大疼痛评分相关。接受右美托咪定治疗的患者住院时间缩短了19小时(p<；0.001)。两组患者的药物不良事件或住院费用在统计学上没有显著差异。术后右美托咪定的使用与阿片类药物使用的减少、疼痛评分的降低以及住院时间的缩短有关。右美托咪定可以被认为是一种安全的辅助药物，对这类患者可能具有阿片类药物的节制作用。
The aim of this study was to determine the association of post-operative dexmedetomidine with markers of pain in children undergoing Chiari malformation decompressions. We hypothesized that patients receiving dexmedetomidine postoperatively will have decreased cumulative opiate use. We further hypothesized that there will be no difference in median pain scores, outcomes, or medication adverse events. An IRB-approved retrospective cohort study of patients undergoing Chiari malformation decompression from December 1, 2015 – December 31, 2018 was performed. Patients aged 0–21 years who underwent intradural Chiari malformation decompression at our institution were included. Data for those who utilized dexmedetomidine postoperatively were compared to those who did not use dexmedetomidine. Our primary outcome was cumulative opiate use throughout hospitalization. Secondary outcomes included pain scores, ancillary medication use, adverse events, length of stay, re-admission rates, and hospital cost. We reviewed 172 patients who underwent Chiari malformation decompression. Of those patients, 86 received dexmedetomidine postoperatively and 86 did not. Demographics were not different between the groups. Patients who received dexmedetomidine postoperatively received more doses of dexamethasone and were also more frequently exposed to dexmedetomidine intraoperatively (p=0.028). Patients that received dexmedetomidine postoperatively used fewer morphine equivalents during their admission (1.01mg/kg versus 1.43mg/kg, p=0.003). The patients that received dexmedetomidine postoperatively also had lower median pain scores on postoperative day zero (0 versus 2, p<0.001), lower median pain scores throughout the entire admission (1 versus 2, p<0.001), and lower maximum pain scores recorded (6 versus 8, p=0.005). Adjusting for steroid dose number and intraoperative dexmedetomidine exposure, postoperative dexmedetomidine remained associated with lower opiate dosing, lower pain scores on POD zero, lower scores throughout hospital stay, and lower maximum pain scores. Patients who received dexmedetomidine had shorter hospital length of stays by 19 hours (p<0.001). There were no statistically significant differences in medication adverse events or hospital costs between the two groups. Postoperative dexmedetomidine utilization was associated with decreased opiate use, lower pain scores, and shorter hospital length of stay in this cohort. Dexmedetomidine may be considered as a safe adjuvant medication that may have opiate sparing effects for this patient population.