Ramez Alzatari, Li-Ching Huang, Benjamin K Poulose
{"title":"阿片类镇痛药与非阿片类镇痛药对腹股沟疝修补术后疼痛程度、生活质量和疗效的影响。","authors":"Ramez Alzatari, Li-Ching Huang, Benjamin K Poulose","doi":"10.1007/s10029-024-02968-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Managing postoperative pain remains a significant challenge in hernia operations. With ventral hernia repair (VHR) being one of the most commonly performed procedures, this study aimed to compare the effectiveness of non-opioid analgesia to opioid-based regimens for postoperative pain management.</p><p><strong>Methods: </strong>The Abdominal Core Health Quality Collaborative was queried for elective VHR patients between 2019-2022. Subjects prescribed opioid or non-opioid analgesics at discharge were matched using a propensity score. Postoperative Hernia-Related Quality of Life Survey (HerQLes) summary scores, Patient-Reported Outcome Measurement Information System (PROMIS) 3a questionnaire, and clinical outcomes were compared between the two groups.</p><p><strong>Results: </strong>1,051 patients who underwent VHR met the study criteria. The 2:1 matched demographics were opioids (n = 188) and non-opioids (n = 94) (median age 63, 48% females, 91% white, and 6.5 cm hernia length). Long-term (1-year post-operation) patients' pain levels were similar between opioids vs non-opioids (median (IQR): 31(31-40) vs. 31(31-40), p = 0.46), and HerQLes summary scores were similar (92(78-100) vs. 90(59-95), p = 0.052). Clinical short-term (30-days post-operation) outcomes between opioid vs non-opioid patients had similar length-of-stay (1(0-5) vs 2(0-6), P = 0.089), readmissions (3% vs. 1%, P = 0.28), recurrences (0% vs. 0%, P = 1), reoperations (1% vs. 0%, P = 0.55), surgical site infections (3% vs. 7%, P = 0.11), surgical site occurrences (5% vs. 6%, P = 0.57), and surgical site occurrences requiring procedural intervention (3% vs. 6%, P = 0.13). Finally, long-term recurrence rates were similar (12% vs. 12%, P = 1).</p><p><strong>Conclusion: </strong>Non-opioid postoperative regimens for analgesia are non-inferior to opioids in VHR patients with similar outcomes. Aggressive efforts should be undertaken to reduce opioid use in this population.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The impact of opioid versus non-opioid analgesics on postoperative pain level, quality of life, and outcomes in ventral hernia repair.\",\"authors\":\"Ramez Alzatari, Li-Ching Huang, Benjamin K Poulose\",\"doi\":\"10.1007/s10029-024-02968-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Managing postoperative pain remains a significant challenge in hernia operations. With ventral hernia repair (VHR) being one of the most commonly performed procedures, this study aimed to compare the effectiveness of non-opioid analgesia to opioid-based regimens for postoperative pain management.</p><p><strong>Methods: </strong>The Abdominal Core Health Quality Collaborative was queried for elective VHR patients between 2019-2022. Subjects prescribed opioid or non-opioid analgesics at discharge were matched using a propensity score. Postoperative Hernia-Related Quality of Life Survey (HerQLes) summary scores, Patient-Reported Outcome Measurement Information System (PROMIS) 3a questionnaire, and clinical outcomes were compared between the two groups.</p><p><strong>Results: </strong>1,051 patients who underwent VHR met the study criteria. The 2:1 matched demographics were opioids (n = 188) and non-opioids (n = 94) (median age 63, 48% females, 91% white, and 6.5 cm hernia length). Long-term (1-year post-operation) patients' pain levels were similar between opioids vs non-opioids (median (IQR): 31(31-40) vs. 31(31-40), p = 0.46), and HerQLes summary scores were similar (92(78-100) vs. 90(59-95), p = 0.052). Clinical short-term (30-days post-operation) outcomes between opioid vs non-opioid patients had similar length-of-stay (1(0-5) vs 2(0-6), P = 0.089), readmissions (3% vs. 1%, P = 0.28), recurrences (0% vs. 0%, P = 1), reoperations (1% vs. 0%, P = 0.55), surgical site infections (3% vs. 7%, P = 0.11), surgical site occurrences (5% vs. 6%, P = 0.57), and surgical site occurrences requiring procedural intervention (3% vs. 6%, P = 0.13). Finally, long-term recurrence rates were similar (12% vs. 12%, P = 1).</p><p><strong>Conclusion: </strong>Non-opioid postoperative regimens for analgesia are non-inferior to opioids in VHR patients with similar outcomes. Aggressive efforts should be undertaken to reduce opioid use in this population.</p>\",\"PeriodicalId\":13168,\"journal\":{\"name\":\"Hernia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hernia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10029-024-02968-3\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/31 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hernia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10029-024-02968-3","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/31 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
目的：处理术后疼痛仍然是疝气手术中的一项重大挑战。腹股沟疝修补术（VHR）是最常见的手术之一，本研究旨在比较非阿片类药物镇痛与阿片类药物镇痛在术后疼痛管理方面的效果：方法：对腹部核心健康质量协作组 2019-2022 年间的择期 VHR 患者进行查询。使用倾向评分对出院时开具阿片类或非阿片类镇痛药的受试者进行匹配。对两组患者的术后疝相关生活质量调查（HerQLes）总分、患者报告结果测量信息系统（PROMIS）3a问卷和临床结果进行比较：1051 名接受 VHR 的患者符合研究标准。2:1 匹配的人口统计学数据为阿片类药物（n = 188）和非阿片类药物（n = 94）（中位年龄 63 岁，女性 48%，白人 91%，疝气长度 6.5 厘米）。阿片类药物与非阿片类药物患者的长期（手术后 1 年）疼痛程度相似（中位数（IQR）：31（31-40）对 31（31-40），P = 0.46），HerQLes 总分相似（92（78-100）对 90（59-95），P = 0.052）。阿片类药物患者与非阿片类药物患者的临床短期（术后 30 天）结果相似：住院时间（1(0-5) vs 2(0-6)，P = 0.089）、再住院率（3% vs. 1%，P = 0.28）、复发率（0% vs. 0%，P = 1）、再次手术率（1% vs. 0%，P = 0.55）。0%，P = 0.55）、手术部位感染（3% vs. 7%，P = 0.11）、手术部位发生率（5% vs. 6%，P = 0.57）和需要手术干预的手术部位发生率（3% vs. 6%，P = 0.13）。最后，长期复发率相似（12% vs. 12%，P = 1）：结论：在VHR患者中，非阿片类药物的术后镇痛方案并不优于阿片类药物，且疗效相似。应积极努力减少阿片类药物在这一人群中的使用。
The impact of opioid versus non-opioid analgesics on postoperative pain level, quality of life, and outcomes in ventral hernia repair.
Purpose: Managing postoperative pain remains a significant challenge in hernia operations. With ventral hernia repair (VHR) being one of the most commonly performed procedures, this study aimed to compare the effectiveness of non-opioid analgesia to opioid-based regimens for postoperative pain management.
Methods: The Abdominal Core Health Quality Collaborative was queried for elective VHR patients between 2019-2022. Subjects prescribed opioid or non-opioid analgesics at discharge were matched using a propensity score. Postoperative Hernia-Related Quality of Life Survey (HerQLes) summary scores, Patient-Reported Outcome Measurement Information System (PROMIS) 3a questionnaire, and clinical outcomes were compared between the two groups.
Results: 1,051 patients who underwent VHR met the study criteria. The 2:1 matched demographics were opioids (n = 188) and non-opioids (n = 94) (median age 63, 48% females, 91% white, and 6.5 cm hernia length). Long-term (1-year post-operation) patients' pain levels were similar between opioids vs non-opioids (median (IQR): 31(31-40) vs. 31(31-40), p = 0.46), and HerQLes summary scores were similar (92(78-100) vs. 90(59-95), p = 0.052). Clinical short-term (30-days post-operation) outcomes between opioid vs non-opioid patients had similar length-of-stay (1(0-5) vs 2(0-6), P = 0.089), readmissions (3% vs. 1%, P = 0.28), recurrences (0% vs. 0%, P = 1), reoperations (1% vs. 0%, P = 0.55), surgical site infections (3% vs. 7%, P = 0.11), surgical site occurrences (5% vs. 6%, P = 0.57), and surgical site occurrences requiring procedural intervention (3% vs. 6%, P = 0.13). Finally, long-term recurrence rates were similar (12% vs. 12%, P = 1).
Conclusion: Non-opioid postoperative regimens for analgesia are non-inferior to opioids in VHR patients with similar outcomes. Aggressive efforts should be undertaken to reduce opioid use in this population.
期刊介绍：
Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery.
Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.
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