术中美沙酮总乳房切除术：一项单一中心回顾性研究
Intraoperative methadone administration for total mastectomy: A single center retrospective study
影响因子:5.10000
分区:医学2区 / 麻醉学2区
发表日期:2024 Nov
作者:
Juan P Cata, Yusuf Zaidi, Juan Jose Guerra-Londono, Evan D Kharasch, Matthew Piotrowski, Spencer Kee, Nicolas A Cortes-Mejia, Jose Miguel Gloria-Escobar, Peter F Thall, Ruitao Lin
摘要
乳腺癌是女性最常见的癌症类型，也是癌症相关死亡率的第二大原因。乳腺切除术仍然是治疗非转移性乳腺癌的关键组成部分，以及治疗急性术后疼痛的策略，这种并发症会影响几乎所有接受手术的患者，仍然是一个重要的临床挑战。这项研究旨在确定术中美沙酮给药的影响与常规的短作用阿片类药物对接受乳房切除术的妇女疼痛相关的围手术期结局的影响。此次单中心回顾性研究包括接受总乳房切除术的成年女性。这项研究的主要结果是手术后第1天术后疼痛强度。次要结果包括围手术期阿片类药物消耗，使用围手术期非阿片类镇痛药，手术持续时间和麻醉时间，拔管时间，麻醉后护理单位的疼痛强度（PACU），PACU中的抗孕药使用以及住院时间。我们使用了基于倾向得分的最接近匹配与1：3的比例来平衡患者基线特征。133例患者接受美沙酮，2192例患者接受了短作用的阿片类药物治疗。该分析表明，美沙酮与口服吗啡等效物测量的术中和术后阿片类药物的消耗显着较低，麻醉后护理单位中的平均疼痛强度得分较低。此外，美沙酮还显示在手术过程中可以减少非阿片类镇痛的使用。
Abstract
Breast cancer is the most frequent type of cancer and the second leading cause of cancer-related mortality in women. Mastectomies remain a key component of the treatment of non-metastatic breast cancer, and strategies to treat acute postoperative pain, a complication affecting nearly all patients undergoing surgery, continues to be an important clinical challenge. This study aimed to determine the impact of intraoperative methadone administration compared to conventional short-acting opioids on pain-related perioperative outcomes in women undergoing a mastectomy.This single-center retrospective study included adult women undergoing total mastectomy. The primary outcome of this study was postoperative pain intensity on day 1 after surgery. Secondary outcomes included perioperative opioid consumption, perioperative non-opioid analgesics use, duration of surgery and anesthesia, time to extubation, pain intensity in the postanesthesia care unit (PACU), anti-emetic use in PACU, and length of stay in hospital. We used the propensity score-based nearest matching with a 1:3 ratio to balance the patient baseline characteristics.133 patients received methadone, and 2192 patients were treated with short-acting opioids. The analysis demonstrated that methadone was associated with significantly lower intraoperative and postoperative opioid consumption as measured by oral morphine equivalents and lower average pain intensity scores in the postanesthesia care unit. Moreover, methadone was also shown to reduce the use of non-opioid analgesia during surgery.Our study suggests that the unique pharmacological properties of methadone, including a short onset of action when given intravenously, long-acting pharmacokinetics, and multimodal effects, are associated with better acute pain management after a total mastectomy.