剖宫产术后阿片类药物的处方和使用模式
Patterns of Opioid Prescription and Use After Cesarean Delivery.
作者信息
Bateman Brian T, Cole Naida M, Maeda Ayumi, Burns Sara M, Houle Timothy T, Huybrechts Krista F, Clancy Caitlin R, Hopp Stephanie B, Ecker Jeffrey L, Ende Holly, Grewe Kasey, Raposo Corradini Beatriz, Schoenfeld Robert E, Sankar Keerthana, Day Lori J, Harris Lynnette, Booth Jessica L, Flood Pamela, Bauer Melissa E, Tsen Lawrence C, Landau Ruth, Leffert Lisa R
机构信息
Department of Anesthesiology, Critical Care, and Pain Medicine and the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, and the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; the Department of Anesthesiology, Columbia University Medical Center, New York, New York; the Division of Obstetric Anesthesiology and the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Michigan Health System, Ann Arbor, Michigan; the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California.
出版信息
Obstet Gynecol. 2017 Jul;130(1):29-35. doi: 10.1097/AOG.0000000000002093.
OBJECTIVE
To define the amount of opioid analgesics prescribed and consumed after discharge after cesarean delivery.
METHODS
We conducted a survey at six academic medical centers in the United States from September 2014 to March 2016. Women who had undergone a cesarean delivery were contacted by phone 2 weeks after discharge and participated in a structured interview about the opioid prescription they received on discharge and their oral opioid intake while at home.
RESULTS
A total of 720 women were enrolled; of these, 615 (85.4%) filled an opioid prescription. The median number of dispensed opioid tablets was 40 (interquartile range 30-40), the median number consumed was 20 (interquartile range 8-30), and leftover was 15 (interquartile range 3-26). Of those with leftover opioids, 95.3% had not disposed of the excess medication at the time of the interview. There was an association between a larger number of tablets dispensed and the number consumed independent of patient characteristics. The amount of opioids dispensed did not correlate with patient satisfaction, pain control, or the need to refill the opioid prescription.
CONCLUSION
The amount of opioid prescribed after cesarean delivery generally exceeds the amount consumed by a significant margin, leading to substantial amounts of leftover opioid medication. Lower opioid prescription correlates with lower consumption without a concomitant increase in pain scores or satisfaction.
目的
确定剖宫产术后出院时开具和使用的阿片类镇痛药的数量。
方法
2014年9月至2016年3月，我们在美国的六个学术医疗中心进行了一项调查。剖宫产术后的女性在出院2周后通过电话联系，并参与了一项关于她们出院时收到的阿片类药物处方以及在家中口服阿片类药物摄入量的结构化访谈。
结果
共纳入720名女性；其中，615名（85.4%）填写了阿片类药物处方。发放的阿片类药片的中位数为40片（四分位间距为30 - 40片），服用的中位数为20片（四分位间距为8 - 30片），剩余15片（四分位间距为3 - 26片）。在有剩余阿片类药物的患者中，95.3%在访谈时未处理多余的药物。发放的药片数量较多与服用数量之间存在关联，且不受患者特征的影响。发放的阿片类药物数量与患者满意度、疼痛控制或阿片类药物处方的再填充需求无关。
结论
剖宫产术后开具的阿片类药物数量通常大大超过服用量，导致大量阿片类药物剩余。较低的阿片类药物处方量与较低的消耗量相关，且疼痛评分或满意度并未随之增加。
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