Department of Urology, University of California-Irvine , Irvine , California.
J Urol. 2019 May;201(5):979-986. doi: 10.1097/JU.0000000000000028.
The opioid problem has reached epidemic proportions and the prescription of opioids after surgery can lead to chronic use. We explored prescribing patterns and opioid use after 3 pelvic floor surgeries (sacral neuromodulation, prolapse repair and mid urethral sling) before and after an educational intervention to reduce opioid prescriptions.
We retrospectively reviewed the amount of opioid medication prescribed to patients who underwent these 3 types of surgeries at our institution from June 2016 to May 2017. A telephone survey of patients was done to quantify opioid use after surgery and satisfaction with pain control. Prescribing recommendations were established based on these results and an educational intervention for clinicians was performed. We then evaluated changes in opioid prescription and use during the 6 months following the intervention. A multiple regression model was used to identify factors associated with variability in opioid use.
Our retrospective review showed that the 122 patients were prescribed 149%, 165% and 136% more mean morphine mg equivalents than were actually used for sacral neuromodulation, mid urethral sling and prolapse repair, respectively. After the educational intervention there was a significant reduction in morphine mg equivalents prescribed for all 3 surgeries in 78 patients (p <0.001). Diabetes (p = 0.001), a chronic pain condition (p = 0.017) and rectocele repair (p = 0.001) were associated with increased opioid use.
Our data demonstrate that over prescription of opioids after pelvic floor surgery and a provider educational intervention resulted in a significant reduction in opioid prescribing without changing patient satisfaction with pain control.
阿片类药物问题已达到流行程度，手术后开阿片类药物可能导致慢性使用。我们探讨了在减少阿片类药物处方的教育干预前后 3 种盆底手术（骶神经调节、脱垂修复和中尿道吊带）后的开方模式和阿片类药物使用情况。
我们回顾性地审查了 2016 年 6 月至 2017 年 5 月在我院接受这 3 种手术的患者开的阿片类药物的数量。对患者进行了电话调查，以量化手术后的阿片类药物使用情况和对疼痛控制的满意度。根据这些结果制定了处方建议，并对临床医生进行了教育干预。然后，我们评估了干预后 6 个月内阿片类药物处方和使用的变化。使用多元回归模型来确定与阿片类药物使用变异性相关的因素。
我们的回顾性研究显示，122 名患者分别被开出了比实际使用的骶神经调节、中尿道吊带和脱垂修复分别多 149%、165%和 136%的平均吗啡毫克当量。在教育干预后，78 名患者的所有 3 种手术的吗啡毫克当量开方量均显著减少（p <0.001）。糖尿病（p = 0.001）、慢性疼痛状况（p = 0.017）和直肠前突修复（p = 0.001）与阿片类药物使用增加有关。
我们的数据表明，盆底手术后阿片类药物的过度处方和提供者教育干预导致阿片类药物处方显著减少，而不会改变患者对疼痛控制的满意度。
