New insight into the analgesic recipe: A cohort study based on smart patient-controlled analgesia pumps records
Purpose: Intravenous patient-controlled analgesia (IV-PCA) has been widely used; however, regimen criteria have not yet been established. In China, the most often used opioid is sufentanil, for which repeated doses are a concern, and empirical flurbiprofen axetil (FBP) as an adjuvant. We hypothesize...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2022.988070/full |
| _version_ | 1811241889896071168 |
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| author | Yiyan Song Qiulan He Wenzhong Huang Lu Yang Shaopeng Zhou Xiaoyu Xiao Zhongxing Wang Wenqi Huang |
| author_facet | Yiyan Song Qiulan He Wenzhong Huang Lu Yang Shaopeng Zhou Xiaoyu Xiao Zhongxing Wang Wenqi Huang |
| author_sort | Yiyan Song |
| collection | DOAJ |
| description | Purpose: Intravenous patient-controlled analgesia (IV-PCA) has been widely used; however, regimen criteria have not yet been established. In China, the most often used opioid is sufentanil, for which repeated doses are a concern, and empirical flurbiprofen axetil (FBP) as an adjuvant. We hypothesized that hydromorphone would be a better choice and also evaluated the effectiveness of FBP as an adjuvant.Methods: This historical cohort study was conducted in two tertiary hospitals in China and included 12,674 patients using hydromorphone or sufentanil for IV-PCA between April 1, 2017, and January 30, 2021. The primary outcome was analgesic insufficiency at static (AIS). The secondary outcomes included analgesic insufficiency with movement (AIM) and common opioid-related adverse effects such as postoperative nausea and vomiting (PONV) and dizziness.Results: Sufentanil, but not the sufentanil-FBP combination, was associated with higher risks of AIS and AIM compared to those for hydromorphone (OR 1.64 [1.23, 2.19], p < 0.001 and OR 1.42 [1.16, 1.73], p < 0.001). Hydromorphone combined with FBP also decreased the risk of both AIS and AIM compared to those for pure hydromorphone (OR 0.74 [0.61, 0.90], p = 0.003 and OR 0.80 [0.71, 0.91], p < 0.001). However, the risk of PONV was higher in patients aged ≤35 years using FBP (hydromorphone-FBP vs. hydromorphone and sufentanil-FBP vs. hydromorphone, OR 1.69 [1.22, 2.33], p = 0.001 and 1.79 [1.12, 2.86], p = 0.015).Conclusion: Hydromorphone was superior to sufentanil for IV-PCA in postoperative analgesia. Adding FBP may improve the analgesic effects of both hydromorphone and sufentanil but was associated with an increased risk of PONV in patients <35 years of age. |
| first_indexed | 2024-04-12T13:43:02Z |
| format | Article |
| id | doaj.art-76f404dee4ff4c558ee5d26d393c812c |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-04-12T13:43:02Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-76f404dee4ff4c558ee5d26d393c812c2022-12-22T03:30:47ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122022-10-011310.3389/fphar.2022.988070988070New insight into the analgesic recipe: A cohort study based on smart patient-controlled analgesia pumps recordsYiyan Song0Qiulan He1Wenzhong Huang2Lu Yang3Shaopeng Zhou4Xiaoyu Xiao5Zhongxing Wang6Wenqi Huang7Department of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, AustraliaDepartment of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Anesthesia, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, ChinaDepartment of Anesthesia, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, ChinaDepartment of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaDepartment of Anesthesia, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaPurpose: Intravenous patient-controlled analgesia (IV-PCA) has been widely used; however, regimen criteria have not yet been established. In China, the most often used opioid is sufentanil, for which repeated doses are a concern, and empirical flurbiprofen axetil (FBP) as an adjuvant. We hypothesized that hydromorphone would be a better choice and also evaluated the effectiveness of FBP as an adjuvant.Methods: This historical cohort study was conducted in two tertiary hospitals in China and included 12,674 patients using hydromorphone or sufentanil for IV-PCA between April 1, 2017, and January 30, 2021. The primary outcome was analgesic insufficiency at static (AIS). The secondary outcomes included analgesic insufficiency with movement (AIM) and common opioid-related adverse effects such as postoperative nausea and vomiting (PONV) and dizziness.Results: Sufentanil, but not the sufentanil-FBP combination, was associated with higher risks of AIS and AIM compared to those for hydromorphone (OR 1.64 [1.23, 2.19], p < 0.001 and OR 1.42 [1.16, 1.73], p < 0.001). Hydromorphone combined with FBP also decreased the risk of both AIS and AIM compared to those for pure hydromorphone (OR 0.74 [0.61, 0.90], p = 0.003 and OR 0.80 [0.71, 0.91], p < 0.001). However, the risk of PONV was higher in patients aged ≤35 years using FBP (hydromorphone-FBP vs. hydromorphone and sufentanil-FBP vs. hydromorphone, OR 1.69 [1.22, 2.33], p = 0.001 and 1.79 [1.12, 2.86], p = 0.015).Conclusion: Hydromorphone was superior to sufentanil for IV-PCA in postoperative analgesia. Adding FBP may improve the analgesic effects of both hydromorphone and sufentanil but was associated with an increased risk of PONV in patients <35 years of age.https://www.frontiersin.org/articles/10.3389/fphar.2022.988070/fullpatient-controlled analgesiasufentanilhydromorphoneflurbiprofenpostoperative nausea and vomitinggeneralized estimation equation |
| spellingShingle | Yiyan Song Qiulan He Wenzhong Huang Lu Yang Shaopeng Zhou Xiaoyu Xiao Zhongxing Wang Wenqi Huang New insight into the analgesic recipe: A cohort study based on smart patient-controlled analgesia pumps records Frontiers in Pharmacology patient-controlled analgesia sufentanil hydromorphone flurbiprofen postoperative nausea and vomiting generalized estimation equation |
| title | New insight into the analgesic recipe: A cohort study based on smart patient-controlled analgesia pumps records |
| title_full | New insight into the analgesic recipe: A cohort study based on smart patient-controlled analgesia pumps records |
| title_fullStr | New insight into the analgesic recipe: A cohort study based on smart patient-controlled analgesia pumps records |
| title_full_unstemmed | New insight into the analgesic recipe: A cohort study based on smart patient-controlled analgesia pumps records |
| title_short | New insight into the analgesic recipe: A cohort study based on smart patient-controlled analgesia pumps records |
| title_sort | new insight into the analgesic recipe a cohort study based on smart patient controlled analgesia pumps records |
| topic | patient-controlled analgesia sufentanil hydromorphone flurbiprofen postoperative nausea and vomiting generalized estimation equation |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2022.988070/full |
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