Willis-Gray Marcella G, Husk Katherine E, Brueseke Taylor J, Wu Jennifer M, Dieter Alexis A
From the Division of Female Pelvic Medicine and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Division of Urogynecology, University of California, Irvine, Irvine, CA.
Female Pelvic Med Reconstr Surg. 2019 Sep/Oct;25(5):347-350. doi: 10.1097/SPV.0000000000000567.
Our primary objective was to evaluate age as a predictor of postanesthesia care unit (PACU) opioid administration in women undergoing reconstructive pelvic surgery. Our secondary objective was to identify additional predictors of PACU opioid administration.
We conducted a retrospective cohort study of women undergoing outpatient urogynecologic surgery for pelvic organ prolapse and/or stress urinary incontinence between September 2015 to October 2016 at 1 academic medical center. We compared 2 cohorts (1) women older than 65 years and (2) women older than 65 years. Our primary outcome was any opioid medication administered during the PACU admission.
A total of 183 women were included in the study; 124 (68%) were younger than 65 years, and 59 (32%) were 65 years or older. For our primary outcome, women younger than 65 years were more likely to be given any opioids in PACU than women 65 years (70% vs 54%, P = 0.04, respectively). Women younger than 65 years were also given higher total amounts of opioid narcotics postoperatively (9.0 ± 8.3 vs 5.1 ± 6.0 mg, P < 0.05). For our secondary outcome, we found that PACU opioid administration was associated with midurethral sling (MUS) surgery (70% MUS vs 30% no MUS, P = 0.04) and high maximum PACU pain score (97% high vs 3% low, P < 0.01).
In women undergoing urogynecologic surgery, age younger than 65 years is a predictor of high PACU pain score and resultant PACU opioid dispensation. This population should be targeted in future studies addressing the use of nonopioid multimodal therapies in the treatment of postoperative pain.
我们的主要目的是评估年龄作为接受盆腔重建手术的女性术后麻醉恢复室（PACU）阿片类药物使用的预测指标。我们的次要目的是确定PACU阿片类药物使用的其他预测指标。
我们对2015年9月至2016年10月在1家学术医疗中心接受门诊泌尿妇科手术治疗盆腔器官脱垂和/或压力性尿失禁的女性进行了一项回顾性队列研究。我们比较了2个队列：（1）65岁以上的女性和（2）65岁以上的女性。我们的主要结局是PACU住院期间给予的任何阿片类药物。
共有183名女性纳入研究；124名（68%）年龄小于65岁，59名（32%）年龄为65岁或以上。对于我们的主要结局，年龄小于65岁的女性在PACU中比65岁的女性更有可能接受任何阿片类药物（分别为70%对54%，P = 0.04）。年龄小于65岁的女性术后给予的阿片类麻醉药总量也更高（9.0±8.3对5.1±6.0 mg，P < 0.05）。对于我们的次要结局，我们发现PACU阿片类药物使用与尿道中段吊带（MUS）手术相关（MUS组为70%，非MUS组为30%，P = 0.04）以及PACU最高疼痛评分高（高评分组为97%，低评分组为3%，P < 0.01）。
在接受泌尿妇科手术的女性中，年龄小于65岁是PACU疼痛评分高及由此导致PACU阿片类药物发放的预测指标。在未来针对非阿片类多模式疗法治疗术后疼痛的研究中，应将这一人群作为目标。
