Abstract：
This retrospective cohort study aimed to compare post-surgical opioid consumption before and after a PCA (patient-controlled analgesia) shortage. The study evaluated patients who received PCA vs. nurse-administered opioid analgesia (non-PCA). Two hundred and twenty-four patients ≥18 years who were initiated on analgesia within 24 h of surgery were included. The primary outcome was opioid consumption in average daily oral morphine milliequivalents (MME). The results showed that patients in the PCA group had increased MME consumption (162 ± 100.4 vs. 70.7 ± 52.8, p < 0.01), increased length of hospital stay (4.2 vs. 3.2 days, p < 0.01), and increased frequency of nausea (33 vs. 17.9%, p < 0.01). After controlling for confounding factors, the PCA group utilized significantly more opioids (84.6 MME/day, p < 0.01) than the non-PCA group. There was no difference in pain AUC/T (0.19 ± 0.07 vs. 0.21 ± 0.08, p = 0.07) and average opioid prescribing upon discharge (150 [77.5-360] vs. 90 [77.5-400], p = 0.64) between the PCA group and non-PCA group, respectively. These results question the routine use of PCA in post-operative patients due to the increased risk of opioid consumption, longer length of hospital stay, and higher incidence of nausea.
摘要：
这项回顾性队列研究旨在比较PCA（患者自控镇痛）短缺之前和之后的术后阿片类药物消耗。该研究评估了接受PCA与PCA的患者。护士管理阿片类药物镇痛（非PCA）。包括在手术后24小时内开始镇痛的24名≥18岁的患者。主要结果是每日平均口服吗啡毫克当量（MME）的阿片类药物消耗量。结果显示，PCA组患者的MME消耗量增加（162±100.4vs.70.7±52.8，p<0.01），住院时间延长(4.2vs.3.2天,p<0.01),和恶心的频率增加(33vs.17.9%,p<0.01)。在控制了混杂因素后，PCA组使用了明显更多的阿片类药物(84.6MME/天，p<0.01)比非PCA组。疼痛AUC/T无差异（0.19±0.07vs.0.21±0.08，p=0.07）和出院时的平均阿片类药物处方（150[77.5-360]与90[77.5-400],p=0.64)在PCA组和非PCA组之间，分别。这些结果对术后患者常规使用PCA提出质疑，因为阿片类药物消耗的风险增加，住院时间更长，和更高的恶心发生率。
