双侧肺移植术后多模式疼痛控制的比较。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-07-01 DOI:10.1016/j.transproceed.2025.05.023

John A. Treffalls , Victoria K. Hart , Connor McDonald , Lara Jones , Holly Keyt , Nitin A. Das , Edward Y. Sako

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引用次数: 0

摘要

目的：阿片类药物在双侧肺移植（BLTx）后很常见，但与不良副作用和潜在的阿片类药物使用障碍有关。本研究旨在比较肋间冷冻消融、脂质体布比卡因（LipoB）和标准治疗对BLTx后患者报告的疼痛、阿片类药物给药和临床结果的影响。方法：回顾性分析2016年1月至2023年12月在单一中心进行的所有BLTx。由于不同的外科医生的偏好，患者接受术中冷冻消融或LipoB除全身疼痛控制措施或全身措施仅在术中或围术期。主要结局包括患者报告的疼痛和阿片类药物给药量。次要结局包括阿片类药物相关并发症和围手术期结局。阿片类药物使用吗啡毫克当量进行标准化。使用混合效应模型预测阿片类药物水平和疼痛评分。结果：在纳入的153例患者中，42.5% （n = 65）接受了全身注射，31.4% （n = 48）接受了LipoB， 26.1% （n = 40）接受了冷冻消融。接受冷冻消融的患者在术后第14天报告疼痛明显减轻（P < 0.0001）。阿片类药物给药组间差异无统计学意义（P = .107）。接受冷冻消融的患者术后肠梗阻发生率较低（P = 0.004），但重症监护病房和术后住院时间较长（P < 0.001）。结论：冷冻消融与患者报告的BLTx后疼痛的临床显著减少有关。冷冻消融组的住院时间明显更长，值得未来的前瞻性随机调查。

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Comparison of Multimodal Pain Control Following Bilateral Lung Transplantation

Purpose

Opioid administration is common following bilateral lung transplantation (BLTx) but is associated with adverse side effects and potential for opioid use disorder. This study aimed to compare the use of intercostal cryoablation, liposomal bupivacaine (LipoB), and standard therapy on patient-reported pain, opioid administration, and clinical outcomes following BLTx.

Methods

A retrospective review of all BLTx performed at a single center from January 2016 to December 2023 was performed. Due to varying surgeon preferences, patients received intraoperative cryoablation or LipoB in addition to systemic pain control measures or systemic measures only in the intra- or peri-operative period. Primary outcomes included patient-reported pain and the amount of opioid administration. Secondary outcomes included opioid-related complications and perioperative outcomes. Opioid administration was standardized using morphine milligram equivalents. Opioid levels and pain scores were predicted using a mixed-effects model.

Results

Of the 153 patients included, 42.5% (n = 65) received systemic-only, 31.4% (n = 48) received LipoB, and 26.1% (n = 40) received cryoablation. Patients receiving cryoablation reported significantly lower pain through postoperative day 14 (P < .0001). Opioid administration was not different between groups (P = .107). Patients receiving cryoablation had lower rates of postoperative ileus (P = .004) but longer intensive care unit and postoperative length of stay (P < .001).

Conclusion

Cryoablation was associated with a clinically significant reduction in patient-reported pain following BLTx. Significantly longer length of stay in the cryoablation group warrants future prospective, randomized investigation.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.