术中使用盐酸美沙酮进行全切乳腺切除术的单中心回顾性研究

Intraoperative methadone administration for total mastectomy: A single center retrospective study

JOURNAL OF CLINICAL ANESTHESIA

影响因子:5.1

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

DOI: 10.1016/j.jclinane.2024.111572

摘要

乳腺癌是女性中最常见的癌症类型，也是癌症相关死亡的第二大原因。乳房切除术仍是非转移性乳腺癌治疗的重要组成部分，而针对术后急性疼痛的治疗策略，作为几乎所有接受手术患者的并发症，依然是临床上的一大挑战。本文旨在比较术中使用盐酸美沙酮与常规短效阿片类药物对乳腺切除术患者围手术期疼痛相关结局的影响。为此，我们进行了一项单中心的回顾性研究，纳入接受全切乳腺切除术的成人女性。主要观察指标为术后第1天的疼痛强度。次要指标包括围手术期阿片类药物使用量、非阿片类镇痛药使用情况、手术及麻醉持续时间、拔管时间、术后苏醒室（PACU）疼痛强度、PACU的止吐药使用以及住院时间。采用倾向评分匹配（1:3比例）平衡患者基本特征。共有133例患者接受美沙酮治疗，2192例使用短效阿片类药物。分析结果显示，美沙酮显著降低了术中及术后口服吗啡当量的阿片类药物用量，以及苏醒室的平均疼痛评分。此外，美沙酮还能减少手术期间非阿片类镇痛药的使用。研究表明，美沙酮的药理特性，包括静脉给药时起效快、作用持久及多模式作用，有助于改善全切乳腺切除术后的急性疼痛管理。

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.