Intraoperative Hydromorphone Decreases Post-Operative Pain Who Would Have Thought? An Instrumental Variable Analysis

Brent Ershoff
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Abstract

Background A growing body of literature suggests that intraoperative opioid administration can lead to both increased post-operative pain and opioid requirements. However, there has been minimal data regarding the effects of the intraoperative administration of intermediate duration opioids such as hydromorphone on post-operative outcomes. Causal inference using observational studies is often hampered by unmeasured confounding, where classical adjustment techniques, such as multivariable regression, are insufficient. Instrumental variable analysis is able to generate unbiased causal effect estimates in the presence of unmeasured confounding, assuming a valid instrumental variable can be found. We previously demonstrated, using a natural experiment, how hydromorphone presentation dose, i.e. the unit dose provided to the clinician, affects intraoperative administration dose, with the switch from a 2-mg to a 1-mg vial associated with decreased administration. As the change in hydromorphone presentation dose was unrelated to any external factors, presentation dose could serve as an instrumental variable to estimate the effect of intraoperative hydromorphone administration dose on post-operative outcomes.
谁能想到术中氢吗啡酮能减轻术后疼痛?工具变量分析
越来越多的文献表明,术中给药阿片类药物会导致术后疼痛和阿片类药物需求增加。然而,关于术中使用中期阿片类药物(如氢吗啡酮)对术后结果的影响的数据很少。利用观察性研究进行的因果推理常常受到未测量的混杂因素的阻碍,其中经典的调整技术,如多变量回归,是不够的。假设可以找到有效的工具变量,工具变量分析能够在存在未测量的混淆的情况下产生无偏的因果效应估计。我们之前通过自然实验证明了氢吗啡酮给药剂量,即提供给临床医生的单位剂量,如何影响术中给药剂量,从2毫克小瓶切换到1毫克小瓶与减少给药有关。由于氢吗啡酮呈现剂量的变化与任何外界因素无关,呈现剂量可作为评估术中氢吗啡酮给药剂量对术后预后影响的工具变量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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