Intraoperative Methadone in Next-day Discharge Outpatient Surgery: A Randomized, Double-blinded, Dose-finding Pilot Study.
Intraoperative Methadone in Next-day Discharge Outpatient Surgery: A Randomized, Double-blinded, Dose-finding Pilot Study.
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次日出院门诊手术中的术中美沙酮：一项随机、双盲、剂量探索试点研究。
DOI：
10.1097/aln.0000000000004663
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发表时间：
2023
期刊：
影响因子：
8.8
通讯作者：
Komen,Helga
中科院分区：
文献类型：
--
作者：
Kharasch,EvanD;Brunt,LMichael;Blood,Jane;Komen,Helga
背景当代围手术期实践旨在减少术中阿片类药物的使用，减少术后疼痛和阿片类药物的使用，并减少出院后阿片类药物的处方。对于住院手术，与短期阿片类药物相比，术中美沙酮麻醉可减少疼痛，减少术后阿片类药物的使用，提高患者满意度。这项初步研究旨在确定第二天出院门诊手术单剂量术中美沙酮的可行性，确定最佳镇痛和耐受良好的剂量，并探讨美沙酮是否会导致术后阿片类药物的使用比传统的短期阿片类药物少。剂量递增的可行性和在次日出院手术中比较术中单次静脉注射美沙酮的初步研究（0.1，然后0.2，0.25和0.3 mg/kg理想体重）与按需短期阿片类药物（芬太尼，氢吗啡酮）对照。出院前评估围手术期阿片类药物的使用、疼痛和副作用。患者使用带回家的日记记录术后30天的疼痛、阿片类药物使用和副作用。主要临床结局为院内（术中和术后）阿片类药物使用。次要结果是30天阿片类药物的消费，疼痛，阿片类药物的副作用，和遗留的阿片类counts.ResultsMedian（IQR）术中美沙酮剂量分别为6（5-7），11（10-12），14（13-16），和18（15-19）毫克，0.1，0.2，0.25，和0.3毫克/公斤的理想体重组，分别。单剂量美沙酮和丙泊酚或挥发性麻醉药麻醉有效。在接受0.1、0.2、0.25和0.3 mg/kg美沙酮的患者中，院内阿片类药物总使用量（mg IV吗啡当量）分别为25（20-37）、20（13-30）、27（18-32）和25（20-36）mg，而短期阿片类药物对照组为46（33-59）mg。阿片类药物相关的副作用在数值上没有差异。家庭疼痛和阿片类药物的使用在数字上较低的患者接受美沙酮。ConclusionThe最有效的和耐受性良好的单术中诱导剂量的美沙酮第二天出院手术是0.25毫克/公斤的理想体重（中位数14毫克）。单剂量术中美沙酮在第二天出院门诊手术中具有镇痛和阿片类药物节省作用。
BackgroundContemporary perioperative practice seeks to use less intraoperative opioid, diminish postoperative pain and opioid use, and enable less post-discharge opioid prescribing. For inpatient surgery, anesthesia with intraoperative methadone, compared with short-duration opioids, results in less pain, less postoperative opioid use, and greater patient satisfaction. This pilot investigation aimed to determine single-dose intraoperative methadone feasibility for next-day discharge outpatient surgery, determine an optimally analgesic and well-tolerated dose, and explore whether methadone would result in less postoperative opioid use compared with conventional short-duration opioids.MethodsThis double-blind, randomized, dose-escalation feasibility and pilot study in next-day discharge surgery compared intraoperative single-dose intravenous methadone (0.1 then 0.2, 0.25 and 0.3 mg/kg ideal body weight) versus as-needed short-duration opioid (fentanyl, hydromorphone) controls. Perioperative opioid use, pain, and side effects were assessed before discharge. Patients recorded pain, opioid use, and side effects for 30 days postoperatively using take-home diaries. Primary clinical outcome was in-hospital (intraoperative and postoperative) opioid use. Secondary outcomes were 30d opioid consumption, pain, opioid side effects, and left-over opioid counts.ResultsMedian (IQR) intraoperative methadone doses were 6 (5-7), 11 (10-12), 14 (13-16), and 18 (15-19) mg in 0.1, 0.2, 0.25, and 0.3 mg/kg ideal body weight groups, respectively. Anesthesia with single-dose methadone and propofol or volatile anesthetic was effective. Total in-hospital opioid use (mg IV morphine equivalents) was 25 (20-37), 20 (13-30), 27 (18-32), and 25 (20-36) mg, respectively, in patients receiving 0.1, 0.2, 0.25 and 0.3 mg/kg methadone, compared to 46 (33-59) mg in short-duration opioid controls. Opioid-related side effects were not numerically different. Home pain and opioid use were numerically lower in patients receiving methadone.ConclusionThe most effective and well-tolerated single intraoperative induction dose of methadone for next-day discharge surgery was 0.25 mg/kg ideal body weight (median 14 mg). Single-dose intraoperative methadone was analgesic and opioid-sparing in next-day discharge outpatient surgery.