术后疼痛、阿片类药物用量和活动

2021-11-22 11:52

术后疼痛、阿片类药物用量和活动

本文由“小麻哥的日常”授权转载

摘要译文

术后疼痛、阿片类药物用量和活动:两项随机试验的事后分析

1.背景:

早期活动被纳入许多增强康复途径。

镇痛不足或阿片类药物过量可能限制术后活动。

作者验证了以下假设:

????在腹部手术后康复的成年人中，术后疼痛和阿片类药物用量与术后活动负相关。

????术后活动与较少的潜在相关并发症相关。

2.方法:

作者对两项试验进行了亚分析，这两项试验纳入了腹部手术后康复的成年患者。

使用无创无线监护仪连续监测术后48小时的姿势和运动。

活动被定义为监测过程中花费一定时间坐着或站着。

3.结果:

总共673名患者被纳入本研究。

监测过程中坐或站的时间中位数[四分位数范围]为7%[3 - 13%]。

????平均疼痛评分为3分或更低的患者活动时间为1.9 [1.0 - 3.6]h/d，而平均疼痛评分为6分或更高的患者仅为1.2 [0.5 - 2.6]h/d。

????平均疼痛评分每增加一个单位，运动时间就减少0.12 (97.5% CI, 0.02 - 0.24;P = 0.009) h/d。

????相比之下，术后阿片类药物用量与活动时间之间没有相关性。

????术后并发症的发生率在四分位低活动位组为6.0%(10 / 168)，在四分位中次低活动位组为4.2%(7 / 168)，四分位高的两个活动位组为337例患者为0% (P = 0.009)。

4.结论:

在腹部手术后的恢复时间里，活动时间仅占7%，这比推荐的时间要少得多。

较低的疼痛评分与活动增加有关，与阿片类药物的用量无关。

在活动少的患者并发症中更为常见。

原文摘要

Pain and Opioid Consumption and Mobilization after Surgery: Post Hoc Analysis of Two Randomized Trials

Background: Early mobilization is incorporated into many enhanced recovery pathways. Inadequate analgesia or excessive opioids may restrict postoperative mobilization. The authors tested the hypotheses that in adults recovering from abdominal surgery, postoperative pain and opioid consumption are inversely related to postoperative mobilization, and that postoperative mobilization is associated with fewer potentially related complications.

Methods: The authors conducted a subanalysis of two trials that enrolled adults recovering from abdominal surgery. Posture and movement were continuously monitored for 48 postoperative hours using noninvasive untethered monitors. Mobilization was defined as the fraction of monitored time spent sitting or standing.

Results: A total of 673 patients spent a median [interquartile range] of 7% [3 to 13%] of monitored time sitting or standing. Mobilization time was 1.9 [1.0 to 3.6] h/day for patients with average pain scores 3 or lower, but only 1.2 [0.5 to 2.6] h/day in those with average scores 6 or greater. Each unit increase in average pain score was associated with a decrease in mobilization time of 0.12 (97.5% CI, 0.02 to 0.24; P = 0.009) h/day. In contrast, there was no association between postoperative opioid consumption and mobilization time. The incidence of the composite of postoperative complications was 6.0% (10 of 168) in the lower mobilization quartile, 4.2% (7 of 168) in the second quartile, and 0% among 337 patients in the highest two quartiles (P = 0.009).

Conclusions: Patients recovering from abdominal surgery spent only 7% of their time mobilized, which is considerably less than recommended. Lower pain scores are associated with increased mobility, independently of opioid consumption. Complications were more common in patients who mobilized poorly.