Cecilie Siggaard Knoph, James Lucocq, Sivesh Kathir Kamarajah, Søren Schou Olesen, Michael Jones, Jayanta Samanta, Rupjyoti Talukdar, Gabriele Capurso, Enrique de-Madaria, Dhiraj Yadav, Ajith K Siriwardena, John Windsor, Asbjørn Mohr Drewes, Manu Nayar, Sanjay Pandanaboyana
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引用次数: 0
摘要
背景：由于目前国际上尚未就急性胰腺炎（AP）疼痛治疗的最佳方法达成共识，因此不同医疗机构的镇痛方法可能有所不同：本研究探讨了住院急性胰腺炎患者在入院和出院时使用镇痛剂（尤其是阿片类药物）的全球差异：这是对前瞻性 PAINAP 数据库进行的一项事后分析，该数据库包括 2022 年 4 月至 6 月间所有入院的 AP 患者，并进行了为期 1 个月的随访。记录了入院和出院时的人口统计学细节、镇痛药使用情况和临床结果。通过多变量回归分析确定了入院时和出院时阿片类药物使用的比值比（ORs）：在三大洲的 1864 名患者（52% 为男性，中位年龄为 56 岁（四分位数间距为 41-71））中，单纯镇痛剂是主要的镇痛药物（70%）。欧洲中心入院时阿片类药物使用率最低（67%）。亚洲的入院率为 2.53（95% 置信区间 (CI)，1.59-4.04），P 结论：阿片类药物在治疗 AP 疼痛方面的使用存在很大的洲际差异。因此，有必要制定有关 AP 疼痛治疗的国际指南。
Global trends in opioid use for pain management in acute pancreatitis: A multicentre prospective observational study.
Background: Since there is no current international consensus on the optimal approach for pain management in acute pancreatitis (AP), analgesic practices may vary across different healthcare settings.
Objective: This study explored global disparities in analgesic use, in particular opioids, during admission and at discharge in hospitalised AP patients.
Methods: This was a post hoc analysis of the prospective PAINAP database, which included all admissions for AP between April and June 2022 with a 1-month follow-up. Demographic details, analgesic use, and clinical outcomes were recorded during admission and at discharge. Odds ratios (ORs) for opioid use during admission and at discharge were identified using multivariable regression analyses.
Results: Amongst the 1864 patients (52% males, median age 56 (interquartile range, 41-71)) across three different continents, simple analgesics were predominantly used as the primary analgesic (70%). Opioid use during admission was lowest in European centres (67%). Admission in Asian (OR, 2.53 (95% confidence interval (CI), 1.59-4.04), p < 0.001), and Australian (OR, 5.81 (95% CI, 3.19-10.56), p < 0.001) centres was associated with opioid administration during admission compared with European centres. Increased pain severity, longer pre-admission pain duration, organ failure, and longer length of admission increased opioid use during admission. At discharge, Asian (OR, 2.01 (95% CI, 1.40-2.88), p < 0.001) and Australian (OR, 1.91 (95% CI, 1.28-2.85), p = 0.002) centres were associated with opioid prescription compared with European centres. Increased pain severity, longer pre-admission pain duration, acute necrotic collections, and walled-off necrosis also increased the likelihood of opioid prescription at discharge.
Conclusion: There are substantial intercontinental differences in opioid use for AP pain. Accordingly, there is a need for international guidelines on pain management in AP.
期刊介绍：
United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
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