Murphey Alexander W, Munawar Suqrat, Nguyen Shaun A, Meyer Ted A, O'Rourke Ashli K
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
World J Otorhinolaryngol Head Neck Surg. 2019 May 9;5(2):112-116. doi: 10.1016/j.wjorl.2019.03.004. eCollection 2019 Jun.
Determine current opioid prescribing patterns for adult procedures within an academic Otolaryngology-Head and Neck Surgery training program in order to establish a general guideline and more uniform approach to narcotic prescribing practices.
The is a prospective, single-center pilot study. An online, anonymous survey was sent to all members of the Otolaryngology-Head and Neck Surgery training program at Medical University of South Carolina including residents, fellows, and attending surgeons, and advanced practice providers (APP). The survey consisted of questions including demographics, most commonly prescribed analgesic and the average number of opioid tablets prescribed post-operatively for eleven of the most common adult procedures within Otolaryngology.
Forty-two participants responded to the survey. Of the 42 respondents, 20 were attending surgeons, 11 junior level residents (year 1-3), 6 senior level residents (year 4-5), and 5 A.P.P.s. The most commonly prescribed narcotic was hydrocodone-acetaminophen with 83.3% (35/42) of respondents prescribing this medication. Tonsillectomy or uvulopalatopharyngoplasty had the highest average number of tablets prescribed at 32.3 (Range: 5 to 90). Neck dissection, parotidectomy, and thyroidectomy procedures all averaged over 20 tablets. Direct laryngoscopy opioid dose was the lowest at 4.8 tablets (range 0-20). Opioid prescriptions by surgery were broken down by provider class with only septoplasty showing a significant difference with attending physicians prescribing an average of 20 tablets 14.1 tablets for residents ( = 0.034).
We believe there remains an unacceptably high variability in current opioid prescribing patterns within otolaryngology especially within more painful procedures. Establishment of standardized post-operative narcotic guidelines is warranted.
确定一所学术性耳鼻咽喉头颈外科学培训项目中成人手术当前的阿片类药物处方模式，以便建立一般指南和更统一的麻醉处方实践方法。
这是一项前瞻性单中心试点研究。向南卡罗来纳医科大学耳鼻咽喉头颈外科学培训项目的所有成员发送了一份在线匿名调查问卷，包括住院医师、研究员、主治外科医生和高级执业提供者（APP）。该调查包括一些问题，如人口统计学信息、最常开具的镇痛药以及耳鼻咽喉科11种最常见成人手术后开具的阿片类药物片剂的平均数量。
42名参与者回复了调查。在42名受访者中，20名是主治外科医生，11名是初级住院医师（1 - 3年级），6名是高级住院医师（4 - 5年级），5名是高级执业提供者。最常开具的麻醉药是氢可酮 - 对乙酰氨基酚，83.3%（35/42）的受访者开具这种药物。扁桃体切除术或悬雍垂腭咽成形术开具的片剂平均数量最高，为32.3片（范围：5至90片）。颈部清扫术、腮腺切除术和甲状腺切除术的平均片剂数量均超过20片。直接喉镜检查的阿片类药物剂量最低，为4.8片（范围0 - 20片）。按提供者类别对手术的阿片类药物处方进行了分类，只有鼻中隔成形术显示出显著差异，主治医生平均开具20片，住院医师平均开具14.1片（P = 0.034）。
我们认为，目前耳鼻咽喉科的阿片类药物处方模式存在高得令人无法接受的变异性，尤其是在更疼痛的手术中。制定标准化的术后麻醉指南是有必要的。
