Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI; Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
J Am Coll Surg. 2019 Sep;229(3):316-322. doi: 10.1016/j.jamcollsurg.2019.04.020. Epub 2019 May 30.
Opioids are overprescribed after surgical procedures, leading to dependence and diversion into the community. This can be mitigated by evidence-based prescribing practices. We investigated the feasibility of an opioid-sparing pain management strategy after surgical procedures.
Patients undergoing 6 procedures were offered the opportunity to participate in an opioid-sparing pain management pathway. Patients were advised to use acetaminophen and ibuprofen, and were provided with a small "rescue" opioid prescription for breakthrough pain. They were then surveyed postoperatively about opioid use and patient-reported outcomes measures. Overall cohort characteristics and differences between opioid users and non-users were analyzed.
A total of 190 patients were analyzed. Median prescription size was 5 (interquartile range [IQR] 4 to 6) pills and opioid use was 0 (IQR 0 to 4) pills. Fifty-two percent of patients used no opioids after procedures. Median number of leftover pills was 2 (IQR 0 to 5). Median pain score was 1 (IQR 1 to 2) and satisfaction score was 10 (IQR 8 to 10). Almost all (91%) patients agreed that their pain was manageable. Patients who used opioids were younger (52 ± 14 vs 59 ± 13 years; p = 0.001), reported higher pain scores (2 [IQR 1 to 2] vs 1 [1 to 2]; p = 0.014), received larger rescue prescriptions (6 ± 3 vs 4 ± 4 pills; p = 0.003), and were less likely to agree that their pain was manageable (82% vs 98%; p = 0.001). There were no other significant differences between opioid users and non-users.
Patients reported minimal or no opioid use after implementation of an opioid-sparing pathway, and still reported high satisfaction and pain control. These results demonstrate the effectiveness and acceptability of major reduction and even elimination of opioids after discharge from minor surgical procedures.
手术后阿片类药物过度处方，导致依赖和转移到社区。通过循证处方实践可以减轻这种情况。我们调查了手术后使用阿片类药物进行节约疼痛管理策略的可行性。
接受 6 种手术的患者有机会参与节约阿片类药物的疼痛管理途径。建议患者使用对乙酰氨基酚和布洛芬，并为他们提供少量用于缓解突破性疼痛的“急救”阿片类药物处方。然后在手术后对他们进行关于阿片类药物使用和患者报告的结果措施的调查。分析了总体队列特征和阿片类药物使用者与非使用者之间的差异。
共分析了 190 名患者。处方剂量中位数为 5 片（四分位距 [IQR] 4 至 6 片），阿片类药物使用量为 0 片（IQR 0 至 4 片）。52%的患者手术后不使用阿片类药物。中位数剩余药丸数为 2 片（IQR 0 至 5 片）。中位数疼痛评分 1 分（IQR 1 至 2 分），满意度评分 10 分（IQR 8 至 10 分）。几乎所有（91%）患者都认为他们的疼痛可以控制。使用阿片类药物的患者年龄较小（52 ± 14 岁 vs 59 ± 13 岁；p = 0.001），报告的疼痛评分较高（2 [IQR 1 至 2] 分 vs 1 [1 至 2] 分；p = 0.014），收到的急救处方较大（6 ± 3 片 vs 4 ± 4 片；p = 0.003），并且不太可能认为他们的疼痛可以控制（82% vs 98%；p = 0.001）。阿片类药物使用者和非使用者之间没有其他显著差异。
实施节约阿片类药物的途径后，患者报告阿片类药物使用量很少或没有，并且仍然报告满意度和疼痛控制很高。这些结果表明，在小型手术出院后，减少甚至消除阿片类药物的效果和可接受性。
