Ramaseshan Aparna S, Tunitsky-Bitton Elena, O'Sullivan David M, Reagan Krista M L, Steinberg Adam C
Department of Research Administration, Hartford Healthcare, Hartford, CT.
MultiCare Urogynecology & Pelvic Reconstructive Surgery, Tacoma, WA.
Female Pelvic Med Reconstr Surg. 2019 Mar/Apr;25(2):e18-e22. doi: 10.1097/SPV.0000000000000686.
The aim of the study was to evaluate the association of patient factors, amount of in-hospital postoperative narcotics, and pain scores on postdischarge narcotic use (PDNU).
This is a secondary analysis of a randomized controlled trial comparing a postoperative usual-care regimen with multimodal pain regimen after pelvic reconstructive surgery. This analysis evaluated patients in the multimodal arm. Postdischarge narcotic use (as mg oral morphine equivalents, MME, calculated from narcotic tablets remaining) was assessed postoperative days 7 to 10. Brief Pain Inventory (BPI) surveys were collected preoperatively and at postoperative day 1. Patient factors were evaluated using univariate and multivariate analysis. Correlations examined the relationships between PDNU and postoperative in-hospital narcotic use and BPI scores.
Sixty-eight patients randomized to the multimodal pain regimen arm had median (interquartile range) PDNU of 22.5 (0-159.4) MME. After excluding postdischarge narcotic nonusers (34.8%), the median PDNU was 127.5 (22.5-180.0) MME. The median PDNU was 172.5 (150.0-180.0) MME after abdominal reconstructive surgery (n = 7), 82.5 (28.1-180.0) MME after laparoscopic reconstructive surgery (n = 22), and 37.5 (13.1-181.2) MME after vaginal reconstructive surgery (n = 14). A linear correlation was noted between the amount of postoperative narcotics used in-hospital and the amount needed postdischarge after abdominal (r = 0.588, P = 0.057), laparoscopic (r = 0.439, P = 0.019), and vaginal (r = 0.455, P = 0.017) reconstructive surgeries. The BPI scores on postoperative day 1 for "average" pain (r = 0.388, P = 0.002) and "now" pain (r = 0.490, P < 0.001), and on postoperative week 1 for "average" pain (r = 0.383, P = 0.002) and "now" pain (r = 0.389, P = 0.002) correlated with PDNU.
Amount of postoperative in-hospital use of narcotic medications and BPI scores can be valuable predictors of PDNU in patients undergoing pelvic reconstructive surgery.
本研究旨在评估患者因素、术后住院期间麻醉药品用量与出院后麻醉药品使用（PDNU）之间的关联。
这是一项随机对照试验的二次分析，该试验比较了盆腔重建手术后的术后常规护理方案与多模式疼痛管理方案。本分析评估了多模式组的患者。出院后麻醉药品使用情况（以口服吗啡当量毫克数，MME表示，根据剩余麻醉药片计算）在术后第7至10天进行评估。术前和术后第1天收集简明疼痛量表（BPI）调查结果。使用单因素和多因素分析评估患者因素。相关性分析检验了PDNU与术后住院期间麻醉药品使用量及BPI评分之间的关系。
随机分配至多模式疼痛管理方案组的68例患者，其PDNU的中位数（四分位间距）为22.5（0 - 159.4）MME。排除出院后未使用麻醉药品的患者（34.8%）后，PDNU的中位数为127.5（22.5 - 180.0）MME。腹部重建手术后（n = 7）PDNU的中位数为172.5（150.0 - 180.0）MME，腹腔镜重建手术后（n = 22）为82.5（28.1 - 180.0）MME，阴道重建手术后（n = 14）为37.5（13.1 - 181.2）MME。腹部（r = 0.588，P = 0.057）、腹腔镜（r = 0.439，P = 0.019）和阴道（r = 0.455，P = 0.017）重建手术后，住院期间使用的术后麻醉药品量与出院后所需麻醉药品量之间存在线性相关性。术后第1天“平均”疼痛（r = 0.388，P = 0.002）和“当前”疼痛（r = 0.490，P < 0.001）的BPI评分，以及术后第1周“平均”疼痛（r = 0.383，P = 0.002）和“当前”疼痛（r = 0.389，P = 0.002）的BPI评分与PDNU相关。
盆腔重建手术患者术后住院期间麻醉药品使用量和BPI评分可作为PDNU的重要预测指标。
