关节镜肩袖修补术后48小时内需要阿片类药物镇痛的影响因素的初步分析

Preliminary Analysis of Influencing Factors of Opioid Analgesics Need Within 48 Hours After Arthroscopic Rotator Cuff Repair

目的探讨关节镜肩袖修补术后48小时内需要阿片类药物镇痛的影响因素。方法回顾性分析2017年3月~2022年7月同一名术者连续90例关节镜肩袖修补术资料。根据术后48小时内是否使用阿片类药物分为阿片组(62例)和对照组(28例),对照组为术后未用镇痛药或常规镇痛方案(非甾体类抗炎药、非阿片类中枢性镇痛药)镇痛效果好的患者,阿片组为经医生评估需使用阿片类药物镇痛或术后常规镇痛方案无效后增加阿片类药物的患者。选择以下因素作为自变量:性别,年龄(是否≥65岁),病程(是否≥4周),体重指数(BMI)(是否≥25),职业(是否在职),有无吸烟饮酒史,是否合并高血压、糖尿病、心脏病,是否有外伤,手术时间(是否≤180 min),撕裂肌腱数量(是否≥2),螺钉数量(是否≥2),有无大结节骨赘,是否中重度撞击。采用单因素分析筛选关节镜肩袖修补术后48小时需要阿片类药物的影响因素。结果单因素分析结果显示,以上自变量中,只有撕裂肌腱数量≥2根是关节镜肩袖修补术后48小时内需要阿片类药物的影响因素(OR=5.263,P=0.007)。结论肩袖撕裂肌腱数量≥2根者肩袖修补术后48小时内疼痛较重,需要阿片类药物镇痛。应重点关注此类患者术后疼痛情况,早期采用多样化的镇痛方案。

Objective To investigate the influencing factors of opioid analgesics need within 48 hours after arthroscopic rotator cuff repair.Methods Clinical data of 90 consecutive arthroscopic rotator cuff repairs by the same operator from March 2017 to July 2022 were retrospectively analyzed.The patients were divided into opioid group(62 patients)and control group(28 patients)according to whether they used opioid analgesics within 48 hours after surgery.The control group consisted of patients who did not use analgesics or who had good analgesic effects with conventional analgesic regimens(non-steroidal anti-inflammatory drugs or non-opioid central analgesics)after surgery,and the opioid group consisted of patients who required opioid analgesics as assessed by the surgeon or who need opioid analgesics because of inefficacy of conventional analgesic regimens.The following factors were selected as independent variables:gender,age(whether≥65 years old),duration of disease(whether≥4 weeks),body mass index(BMI)(whether≥25),occupation(whether employed),with or without a history of smoking and alcohol consumption,hypertension,diabetes,heart disease,and trauma,duration of surgery(whether≤180 min),number of torn tendons(whether≥2),number of screws(whether≥2),large nodular osteophyte,and whether there was moderate-to-severe impingement.Single factor analysis was used to screen the factors influencing the need for opioid analgesics within 48 hours after arthroscopic rotator cuff repair.Results The results of univariate analysis showed that among the above independent variables,only the number of torn tendons≥2 was the factor affecting the need for opioid analgesics within 48 hours after arthroscopic rotator cuff repair(OR=5.263,P=0.007).Conclusions Patients with rotator cuff tears with≥2 tendons had more severe pain within 48 hours after rotator cuff repair,requiring opioid analgesics.Focus should be placed on postoperative pain in such patients,and a diverse analgesic regimen should be used early.