Impact of patient choice for different postcesarean delivery analgesic protocols on opioid consumption: a randomized prospective clinical trial

被引:18
作者
Carvalho, Brendan [1 ]
Sutton, Caitlin Dooley [2 ]
Kowalczyk, John J. [3 ]
Flood, Pamela Dru [1 ]
机构
[1] Stanford Univ, Dept Anesthesiol Perioperat & Pain Med, Sch Med, Stanford, CA 94305 USA
[2] Baylor Coll Med, Dept Anesthesiol, Houston, TX 77030 USA
[3] Harvard Med Sch, Dept Anesthesia Crit Care & Pain Med, Boston, MA 02115 USA
关键词
SHARED DECISION-MAKING; INTRATHECAL MORPHINE; CESAREAN DELIVERY; DOSE-RESPONSE; PAIN; SATISFACTION; ANESTHESIA; GABAPENTIN; OUTCOMES; SECTION;
D O I
10.1136/rapm-2018-100206
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background Choice of postcesarean delivery analgesic protocol may improve pain experience and reduce analgesic requirements. Methods Cesarean delivery patients were randomly assigned either to choose their postcesarean delivery analgesia protocol or to have no choice and receive routine care. Choices were low (50 mu g intrathecal morphine), medium (identical to routine care: 150 mu g intrathecal morphine), or high (300 mu g intrathecal morphine with 600 mg oral gabapentin). All groups received scheduled acetaminophen and ibuprofen. The primary outcome was oxycodone requirements 0-48 hours postdelivery in those offered versus not offered a choice. Results Of 160 women enrolled, 120 were offered a choice and 40 were not offered a choice. There was no difference in oxycodone requirements or pain associated with choice, but those who had a choice expressed more satisfaction than those who did not have a choice (mean (95% CI) difference 5% (0% to 10 %), p=0.005). In the choice group, the high dose group required more oxycodone (5 (0 to 15) mg 0-24 hours after delivery and 15 (10 to 25) mg at 24-48 hours; p=0.05 and p=0.001) versus the low and medium groups. The low dose group had less pruritus (p=0.001), while the high dose group had more vomiting (p=0.01) requiring antiemetic treatment (p=0.04). Conclusion Having a choice compared with no choice routine care did not reduce oxycodone requirements or pain scores. However, women have insight into their analgesic needs; women offered a choice and who chose the higher dose analgesic protocol required more oxycodone, and women who chose the lower dose protocol required less oxycodone. Despite providing additional analgesic (six times more intrathecal morphine plus gabapentin in high dose vs low dose protocols), we still did not equalize postcesarean oxycodone requirement differences between groups.
引用
收藏
页码:578 / 585
页数:8
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