{"title":"芬太尼与吗啡镇痛的住院和长期阿片类药物使用情况:ANALGESIC 试验结果","authors":"Andrew Casamento MBBS, FACEM, FCICM , Angajendra Ghosh MBBS, FACEM, FCICM , Victor Hui MBBS, FANZCA , Ary Serpa Neto PhD, FCICM","doi":"10.1016/j.ccrj.2023.11.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>Opioid use disorder is extremely common. Many long-term opioid users will have their first exposure to opioids in hospitals. We aimed to compare long-term opioid use in patients who received fentanyl vs. morphine analgosedation and assess ICU related risk factors for long-term opioid use.</p></div><div><h3>Design</h3><p>We performed a post-hoc analysis of the Assessment of Opioid Administration to Lead to Analgesic Effects and Sedation in Intensive Care (ANALGESIC) cluster randomised crossover trial of fentanyl and morphine infusions for analgosedation in mechanically ventilated patients.</p></div><div><h3>Setting</h3><p>Two mixed, adult, university affiliated intensive care units in Melbourne, Australia.</p></div><div><h3>Participants</h3><p>Adult patients who were mechanically ventilated and received fentanyl or morphine for analgosedation in the ANALGESIC trial.</p></div><div><h3>Main outcome measures</h3><p>We assessed discharge and long-term (90–365 days) opioid use in opioid-naïve patients at hospital admission according to the agent used for analgosedation.</p></div><div><h3>Results</h3><p>We studied 477 patients (242 fentanyl and 235 morphine). There were no differences between discharge (16.5% vs. 14.0%, p = 0.45), 90–180 day post-discharge use (3.7% vs 2.1%, p = 0.30) or 180–365 day post-discharge use (3.4% vs 1.3%, p = 0.22) of opioids when comparing those patients who received fentanyl vs. those who received morphine. Surgical diagnosis and one chronic condition were associated with increased hospital discharge prescription of opioids, whereas increasing APACHE II score was associated with decreased discharge prescription. No ICU-related factors were associated with long-term opioid use.</p></div><div><h3>Conclusions</h3><p>Approximately one in seven opioid-naïve patients who receive analgosedation for mechanical ventilation in ICU will be prescribed opioid medications at hospital discharge. There was no difference in discharge prescription or long-term use of opioids depending on whether fentanyl or morphine was used for analgosedation.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022275/pdfft?md5=8c3027f35904a1be48e6bb74ee086a39&pid=1-s2.0-S1441277223022275-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Hospital and long-term opioid use according to analgosedation with fentanyl vs. morphine: Findings from the ANALGESIC trial\",\"authors\":\"Andrew Casamento MBBS, FACEM, FCICM , Angajendra Ghosh MBBS, FACEM, FCICM , Victor Hui MBBS, FANZCA , Ary Serpa Neto PhD, FCICM\",\"doi\":\"10.1016/j.ccrj.2023.11.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p>Opioid use disorder is extremely common. Many long-term opioid users will have their first exposure to opioids in hospitals. We aimed to compare long-term opioid use in patients who received fentanyl vs. morphine analgosedation and assess ICU related risk factors for long-term opioid use.</p></div><div><h3>Design</h3><p>We performed a post-hoc analysis of the Assessment of Opioid Administration to Lead to Analgesic Effects and Sedation in Intensive Care (ANALGESIC) cluster randomised crossover trial of fentanyl and morphine infusions for analgosedation in mechanically ventilated patients.</p></div><div><h3>Setting</h3><p>Two mixed, adult, university affiliated intensive care units in Melbourne, Australia.</p></div><div><h3>Participants</h3><p>Adult patients who were mechanically ventilated and received fentanyl or morphine for analgosedation in the ANALGESIC trial.</p></div><div><h3>Main outcome measures</h3><p>We assessed discharge and long-term (90–365 days) opioid use in opioid-naïve patients at hospital admission according to the agent used for analgosedation.</p></div><div><h3>Results</h3><p>We studied 477 patients (242 fentanyl and 235 morphine). There were no differences between discharge (16.5% vs. 14.0%, p = 0.45), 90–180 day post-discharge use (3.7% vs 2.1%, p = 0.30) or 180–365 day post-discharge use (3.4% vs 1.3%, p = 0.22) of opioids when comparing those patients who received fentanyl vs. those who received morphine. Surgical diagnosis and one chronic condition were associated with increased hospital discharge prescription of opioids, whereas increasing APACHE II score was associated with decreased discharge prescription. No ICU-related factors were associated with long-term opioid use.</p></div><div><h3>Conclusions</h3><p>Approximately one in seven opioid-naïve patients who receive analgosedation for mechanical ventilation in ICU will be prescribed opioid medications at hospital discharge. There was no difference in discharge prescription or long-term use of opioids depending on whether fentanyl or morphine was used for analgosedation.</p></div>\",\"PeriodicalId\":49215,\"journal\":{\"name\":\"Critical Care and Resuscitation\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1441277223022275/pdfft?md5=8c3027f35904a1be48e6bb74ee086a39&pid=1-s2.0-S1441277223022275-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care and Resuscitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1441277223022275\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care and Resuscitation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1441277223022275","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Hospital and long-term opioid use according to analgosedation with fentanyl vs. morphine: Findings from the ANALGESIC trial
Objectives
Opioid use disorder is extremely common. Many long-term opioid users will have their first exposure to opioids in hospitals. We aimed to compare long-term opioid use in patients who received fentanyl vs. morphine analgosedation and assess ICU related risk factors for long-term opioid use.
Design
We performed a post-hoc analysis of the Assessment of Opioid Administration to Lead to Analgesic Effects and Sedation in Intensive Care (ANALGESIC) cluster randomised crossover trial of fentanyl and morphine infusions for analgosedation in mechanically ventilated patients.
Setting
Two mixed, adult, university affiliated intensive care units in Melbourne, Australia.
Participants
Adult patients who were mechanically ventilated and received fentanyl or morphine for analgosedation in the ANALGESIC trial.
Main outcome measures
We assessed discharge and long-term (90–365 days) opioid use in opioid-naïve patients at hospital admission according to the agent used for analgosedation.
Results
We studied 477 patients (242 fentanyl and 235 morphine). There were no differences between discharge (16.5% vs. 14.0%, p = 0.45), 90–180 day post-discharge use (3.7% vs 2.1%, p = 0.30) or 180–365 day post-discharge use (3.4% vs 1.3%, p = 0.22) of opioids when comparing those patients who received fentanyl vs. those who received morphine. Surgical diagnosis and one chronic condition were associated with increased hospital discharge prescription of opioids, whereas increasing APACHE II score was associated with decreased discharge prescription. No ICU-related factors were associated with long-term opioid use.
Conclusions
Approximately one in seven opioid-naïve patients who receive analgosedation for mechanical ventilation in ICU will be prescribed opioid medications at hospital discharge. There was no difference in discharge prescription or long-term use of opioids depending on whether fentanyl or morphine was used for analgosedation.
期刊介绍:
ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines.
The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world.
The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.