Variability in Intraoperative Opioid and Nonopioid Utilization During Intracranial Surgery: A Multicenter, Retrospective Cohort Study.
Variability in Intraoperative Opioid and Nonopioid Utilization During Intracranial Surgery: A Multicenter, Retrospective Cohort Study.
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颅内手术期间阿片类药物和非阿片类药物使用的变异性：一项多中心、回顾性队列研究。
DOI：
10.1097/ana.0000000000000960
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发表时间：
2024
影响因子：
3.7
通讯作者：
MulticenterPerioperativeOutcomesCollaboratorGroup
中科院分区：
文献类型：
--
作者：
Naik,BhikenI;Lele,AbhijitV;Sharma,Deepak;Akkermans,Annemarie;Vlisides,PhillipE;Colquhoun,DouglasA;Domino,KarenB;Tsang,Siny;Sun,Eric;Dunn,LaurenK;MulticenterPerioperativeOutcomesCollaboratorGroup
背景：颅内手术的主要目标是促进快速苏醒和拔管，以进行早期神经系统评估。由于人们认为长效阿片类药物有镇静和延迟苏醒的风险，因此通常避免使用或以亚治疗剂量使用。然而，颅内手术后镇痛不足和术后疼痛增加是常见的。在这项多中心研究中，我们描述了接受颅内手术的患者阿片类药物和非阿片类药物给药模式的变异性。方法：这是一项使用多中心围手术期结果组数据库的多中心、回顾性观察队列研究。描述了美国 11 家机构中 31,217 例接受颅内手术的阿片类药物和非阿片类药物的实践模式。 结果：在所有 11 家机构中，口服吗啡当量的总中位数[四分位数范围]，按体重和麻醉持续时间标准化为 0.17（0.08 至 0.3）mg。公斤。分钟-1。最低（0.05 [0.02 至 0.13] mg. kg. min-1）和最高（0.36 [0.18 至 0.54] mg. kg. min-1）处方机构之间的口服吗啡当量存在 7 倍差异。与接受幕下手术的患者相比，接受幕上手术的患者具有更高的标准化口服吗啡当量[0.17 [0.08-0.31] vs. 0.15 [0.07-0.27] mg/kg/min-1； P<0.001）；然而，这种差异在临床上很小。各机构中 20% 至 96.8% 的病例未使用非阿片类镇痛药。结论：本研究发现机构层面阿片类药物和非阿片类药物的使用存在很大差异。未来的工作
Background: Key goals during intracranial surgery are to facilitate rapid emergence and extubation for early neurologic evaluation. Longer-acting opioids are often avoided or administered at subtherapeutic doses due to their perceived risk of sedation and delayed emergence. However, inadequate analgesia and increased postoperative pain are common after intracranial surgery. In this multicenter study, we describe variability in opioid and nonopioid administration patterns in patients undergoing intracranial surgery.Methods: This was a multicenter, retrospective observational cohort study using the Multicenter Perioperative Outcomes Group database. Opioid and nonopioid practice patterns in 31,217 cases undergoing intracranial surgery across 11 institutions in the United States are described.Results: Across all 11 institutions, total median [interquartile range] oral morphine equivalents, normalized to weight and anesthesia duration was 0.17 (0.08 to 0.3) mg. kg. min-1. There was a 7-fold difference in oral morphine equivalents between the lowest (0.05 [0.02 to 0.13] mg. kg. min-1) and highest (0.36 [0.18 to 0.54] mg. kg. min-1) prescribing institutions. Patients undergoing supratentorial surgery had higher normalized oral morphine equivalents compared with those having infratentorial surgery [0.17 [0.08-0.31] vs. 0.15 [0.07-0.27] mg/kg/min-1; P< 0.001); however, this difference is clinically small. Nonopioid analgesics were not administered in 20% to 96.8% of cases across institutions.Conclusion: This study found wide variability for both opioid and nonopioid utilization at an institutional level. Future work
影响因子：
3.7
作者：
Peng, Yuming;Zhang, Wei;Han, Ruquan
通讯作者：
Han, Ruquan
影响因子：
1.1
作者：
Kotak, D.;Cheserem, B.;Solth, A.
通讯作者：
Solth, A.
影响因子：
5.7
作者：
Naik, Bhiken, I;Kuck, Kai;Pace, Nathan L.
通讯作者：
Pace, Nathan L.