Department of Otolaryngology-Head and Neck Surgery, Department of Anesthesiology, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, NY.
Department of Anesthesiology, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, NY.
Int Forum Allergy Rhinol. 2019 Apr;9(4):339-344. doi: 10.1002/alr.22260. Epub 2018 Dec 3.
Opioid-based analgesics are routinely prescribed after elective rhinologic surgery. Balancing appropriate pain management while avoiding overprescription necessitates an evidence-based approach.
Patients undergoing elective rhinologic surgery, including endoscopic sinus surgery (ESS), septoplasty, or ESS with septoplasty, were prospectively enrolled. Patients completed demographic and psychometric questionnaires assessing attitudes toward pain, baseline anxiety, and depression before surgery. Postoperatively, patients documented peak pain levels (0-100 visual analog scale) and daily prescription and nonprescription medication requirements over a 2-week period.
Of the 42 patients enrolled, 15 underwent ESS, 14 septoplasty, and 13 ESS with septoplasty. Five patients (11.9%) reported a history of chronic pain before surgery. Patients were given a median of 30 opioid pain pills after surgery: acetaminophen with codeine 325/30 mg (10 patients) or oxycodone with acetaminophen 5/325 mg (32 patients). Patients had a median of 27 pills left over at the end of the study period. Median peak pain levels for all procedures were 22 (range, 0-94) on day 0, 26.5 (range, 0-86) on day 1, 8.5 (range, 0-85) on day 3, and 3 (range, 0-52) on day 7. Median opioid requirements measured in morphine milligram equivalents (MME) over those same days were 6.0, 4.1, 0, and 0, respectively.
Postoperative pain after elective rhinologic surgery appears to peak over the first 3 days and decreases rapidly afterward. Most patients require a few doses of opioid analgesics. Opioid requirements and pain levels did not vary based on surgeon, type and extent of surgery, and demographic factors. Judicious prescribing of opioid medication after rhinologic surgery represents a practical opportunity for rhinologists and otolaryngologists to reduce opioid overprescription and abuse.
在择期鼻科手术后，常规开具阿片类镇痛药。平衡适当的疼痛管理和避免过度处方需要循证方法。
前瞻性纳入接受择期鼻科手术（包括内镜鼻窦手术[ESS]、鼻中隔成形术或 ESS 联合鼻中隔成形术）的患者。患者在术前完成评估疼痛态度、基线焦虑和抑郁的人口统计学和心理计量学问卷。术后，患者在 2 周内记录峰值疼痛水平（0-100 视觉模拟评分）和每日处方和非处方药物需求。
在纳入的 42 名患者中，15 名接受 ESS、14 名接受鼻中隔成形术和 13 名接受 ESS 联合鼻中隔成形术。5 名患者（11.9%）术前有慢性疼痛病史。术后患者平均给予 30 片阿片类止痛药：氨酚可待因 325/30mg（10 例）或对乙酰氨基酚与羟考酮 5/325mg（32 例）。研究结束时，患者平均剩余 27 片。所有手术的中位峰值疼痛水平分别为 0 天 22（0-94）、1 天 26.5（0-86）、3 天 8.5（0-85）和 7 天 3（0-52）。在相同的日子里，以吗啡毫克当量（MME）测量的中位阿片类药物需求分别为 6.0、4.1、0 和 0。
择期鼻科手术后的术后疼痛似乎在头 3 天达到高峰，之后迅速下降。大多数患者需要几剂阿片类镇痛药。阿片类药物需求和疼痛水平与外科医生、手术类型和范围以及人口统计学因素无关。在鼻科手术后明智地开具阿片类药物处方为耳鼻喉科医生提供了一个切实可行的机会，可以减少阿片类药物的过度处方和滥用。
