Postoperative Pain and Analgesic Requirements in the First Year after Intraoperative Methadone for Complex Spine and Cardiac Surgery
Postoperative Pain and Analgesic Requirements in the First Year after Intraoperative Methadone for Complex Spine and Cardiac Surgery
复制标题
DOI：
10.1097/aln.0000000000003025
复制
发表时间：
2020-02-01
期刊：
影响因子：
8.8
通讯作者：
Szokol, Joseph W.
中科院分区：
文献类型：
--
作者：
Murphy, Glenn S.;Avram, Michael J.;Szokol, Joseph W.
背景资料：美沙酮是一种长效阿片类药物，据报道可降低术后疼痛评分和镇痛需求，并可减轻慢性术后疼痛的发展。对先前两项试验进行二次分析的目的是随访在复杂脊柱或心脏手术中接受单次术中剂量美沙酮或传统阿片类药物的患者。研究方法：脊柱手术患者随机接受0.2 mg/kg美沙酮在手术开始时或2 mg氢吗啡酮在手术关闭时，和心脏手术患者随机接受0.3 mg/kg美沙酮或12 μ g/kg芬太尼术中进行长期结局的预先计划的分析。术后1、3、6和12个月，将评估每周疼痛频率（主要结局）和疼痛强度的疼痛问卷邮寄给受试者。使用Mann-Whitney U检验比较有序数据，使用卡方检验或Fisher精确概率检验比较标称数据。拒绝零假设的标准为P < 0.01。结果如下：手术后3个月，随机接受美沙酮脊柱手术的患者报告慢性疼痛的每周频率较低（0 - 4级中位评分为0 [每周少于1次] vs.氢吗啡酮组3 [每日]，P = 0.004）。随机接受美沙酮心脏手术的患者报告术后疼痛的频率在1个月时（中位数评分为0）低于随机接受芬太尼的患者（中位数评分为2 [每周两次]，P = 0.004）。结论：在脊柱手术后的前3个月（但不是在6个月和12个月）和心脏手术后的第一个月，当疼痛的强度和频率最大时，观察到术中单剂量美沙酮的镇痛效果。
Background: Methadone is a long-acting opioid that has been reported to reduce postoperative pain scores and analgesic requirements and may attenuate development of chronic postsurgical pain. The aim of this secondary analysis of two previous trials was to follow up with patients who had received a single intraoperative dose of either methadone or traditional opioids for complex spine or cardiac surgical procedures. Methods: Preplanned analyses of long-term outcomes were conducted for spinal surgery patients randomized to receive 0.2 mg/kg methadone at the start of surgery or 2 mg hydromorphone at surgical closure, and for cardiac surgery patients randomized to receive 0.3 mg/kg methadone or 12 mu g/kg fentanyl intraoperatively. A pain questionnaire assessing the weekly frequency (the primary outcome) and intensity of pain was mailed to subjects 1, 3, 6, and 12 months after surgery. Ordinal data were compared with the Mann-Whitney U test, and nominal data were compared using the chi-square test or Fisher exact probability test. The criterion for rejection of the null hypothesis was P < 0.01. Results: Three months after surgery, patients randomized to receive methadone for spine procedures reported the weekly frequency of chronic pain was less (median score 0 on a 0 to 4 scale [less than once a week] vs. 3 [daily] in the hydromorphone group, P = 0.004). Patients randomized to receive methadone for cardiac surgery reported the frequency of postsurgical pain was less at 1 month (median score 0) than it was in patients randomized to receive fentanyl (median score 2 [twice per week], P = 0.004). Conclusions: Analgesic benefits of a single dose of intraoperative methadone were observed during the first 3 months after spinal surgery (but not at 6 and 12 months), and during the first month after cardiac surgery, when the intensity and frequency of pain were the greatest.