Department of Obstetrics and Gynecology (Drs. Patanwala, Ouyang, and Fisk), Florida Hospital, Orlando, Florida; Department of Obstetrics and Gynecology (Dr. Patanwala), Indiana University School of Medicine, Indianapolis, Indiana.
Department of Obstetrics and Gynecology (Drs. Patanwala, Ouyang, and Fisk), Florida Hospital, Orlando, Florida; Division of Surgery, Gynecology Section (Drs. Ouyang and Lamvu), Veteran Affairs Medical Center, Orlando, Florida.
J Minim Invasive Gynecol. 2020 May-Jun;27(4):860-867. doi: 10.1016/j.jmig.2019.07.007. Epub 2019 Jul 15.
To compare the amount of opioids (tablets and morphine milligram equivalents [MMEs]) prescribed by physicians and used by patients after benign gynecologic surgery.
Prospective cohort study.
Tertiary center: main hospital operating room and outpatient surgery center.
Women undergoing benign gynecologic surgery.
Major and minor gynecologic surgeries.
The surgery groups were minor laparoscopy (Minor), major minimally invasive (Major), and laparotomy (Laparotomy). Demographic, medical, and surgical data were abstracted from electronic medical records. On postoperative day (POD) 7, women completed a telephone survey describing pain levels, prescription use, and satisfaction with pain control. Patients who continued to use opioids for pain relief were surveyed on POD 14. If use continued, patients were surveyed again on POD 28. The primary outcome was amount of opioid prescribed compared with opioid used. Of 193 screened participants 172 were enrolled (89%), and data were analyzed for 154 (90%): 59 (38%) Major, 71 (56%) Minor, and 24 (16%) Laparotomy. The median number of tablets and MMEs prescribed was lowest for the Minor group (Minor, 24 tablets; Major, 30 tablets; Laparotomy, 30 tablets [p <.01]; Minor, 150 MMEs; Major, 225 MMEs; Laparotomy, 225 MMEs [p = .01]). We found no difference in the number of tablets (Minor, 8; Major, 8; Laparotomy, 9; p = .77) or MMEs used (Minor, 45 MMEs; Major, 45 MMEs; Laparotomy, 55 MME; p = .81) between the groups. On POD 7 there was no difference in median numerical rating scale pain scores (Minor, 3; Major, 2; Laparotomy, 2; p = .07) or satisfaction with analgesia on POD 7 (p = .44), 14 (p = .87), and 28 (p = .18). Patients with prior chronic pain used more total amounts of opioids (68 MME vs 30 MME, p <.01) and were more likely to require opioid refill (odds ratio, 10.4; 95% confidence interval, 1.3-83.6) compared with those without a similar history.
In this cohort, gynecologic surgeons prescribed nearly 3 times more opioid tablets and MMEs than was used by patients despite patients reporting similar levels of pain after minor and major surgeries.
比较行良性妇科手术后医生开具的阿片类药物（片剂和吗啡毫克当量[MME]）数量和患者使用的阿片类药物数量。
前瞻性队列研究。
三级中心：主要医院手术室和门诊手术中心。
行良性妇科手术的女性。
妇科小手术（Minor）、妇科大微创手术（Major）和剖腹手术（Laparotomy）。从电子病历中提取人口统计学、医疗和手术数据。术后第 7 天（POD），女性完成电话调查，描述疼痛程度、处方使用情况和对疼痛控制的满意度。继续使用阿片类药物缓解疼痛的患者在 POD 14 进行调查。如果继续使用，则在 POD 28 再次对患者进行调查。主要结局是与使用的阿片类药物相比，开具的阿片类药物数量。在筛选的 193 名参与者中，有 172 名（89%）入组，对 154 名（90%）参与者的数据进行了分析：59 名（38%）行 Major，71 名（56%）行 Minor，24 名（16%）行 Laparotomy。开具的片剂和 MME 数量最少的是 Minor 组（Minor，24 片；Major，30 片；Laparotomy，30 片[P <.01]；Minor，150 MMEs；Major，225 MMEs；Laparotomy，225 MMEs[P =.01]）。我们发现各组之间使用的片剂数量（Minor，8 片；Major，8 片；Laparotomy，9 片；P =.77）或 MMEs 数量（Minor，45 MMEs；Major，45 MMEs；Laparotomy，55 MMEs；P =.81）没有差异。在 POD 7 时，中位数数字评分量表疼痛评分（Minor，3；Major，2；Laparotomy，2；P =.07）或 POD 7 时的镇痛满意度（P =.44）、POD 14（P =.87）和 POD 28（P =.18）均无差异。有慢性疼痛史的患者使用的阿片类药物总量更多（68 MME 与 30 MME，P <.01），更有可能需要阿片类药物续开（优势比，10.4；95%置信区间，1.3-83.6）。
在本队列中，尽管患者报告小手术和大手术后疼痛程度相似，但妇科外科医生开具的阿片类药物片剂和 MME 数量几乎是患者使用量的 3 倍。
