Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A.
Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A.
Laryngoscope. 2020 May;130(5):1122-1127. doi: 10.1002/lary.28178. Epub 2019 Jul 24.
OBJECTIVES/HYPOTHESIS: The opioid crisis is a public health emergency. There is limited evidence regarding how much opioid medication is necessary and which patients will require additional pain medication following endoscopic sinus surgery (ESS). The objective of this study was to quantify the use of opioids in the first 24 hours following ESS and determine the risk factors associated with increased need for opioid analgesia.
Retrospective chart review.
A review of opioid-naïve patients routinely admitted to the hospital following ESS between June 2016 and August 2018 was performed. Opioid consumption was quantified for each patient and converted to a morphine milligram equivalents (MME) dose. Pain intensity scores were also recorded throughout the postoperative period. Sociodemographic characteristics as well as surgical procedures performed were evaluated for impact on MME.
A total of 130 patients (45.4% female) were included for analysis. The mean opioid dose consumed per patient in the first 24 hours following ESS was 24.1 MME, and the mean pain intensity was 2.4/10. Increasing pain scores were strongly associated with increasing MME (R = 0.78, P < .001). Multiple linear regression identified that patients taking antidepressants required an additional 17.2 MME (95% confidence interval [CI]: 5.5-28.9, P = .004) in the first 24 hours following ESS, whereas patients undergoing papilloma resection required an additional 16.9 MME (95% CI: 2.5-31.4, P = .022).
Patients undergoing ESS require different amounts of opioids for pain control in the immediate postoperative period. A history of antidepressant use and inverted papilloma resection during ESS were associated with increased opioid consumption postoperatively.
4 Laryngoscope, 130:1122-1127, 2020.
目的/假设：阿片类药物危机是一种公共卫生紧急情况。关于内镜鼻窦手术后（ESS）需要多少阿片类药物以及哪些患者需要额外的疼痛药物，证据有限。本研究的目的是量化 ESS 后 24 小时内阿片类药物的使用情况，并确定与增加阿片类药物镇痛需求相关的风险因素。
回顾性图表审查。
对 2016 年 6 月至 2018 年 8 月期间常规住院接受 ESS 的阿片类药物初治患者进行了回顾。对每位患者的阿片类药物消耗量进行了量化，并转换为吗啡毫克当量（MME）剂量。还记录了整个术后期间的疼痛强度评分。评估了社会人口统计学特征以及所进行的手术程序对 MME 的影响。
共纳入 130 例患者（45.4%为女性）进行分析。ESS 后 24 小时内每位患者平均消耗的阿片类药物剂量为 24.1MME，平均疼痛强度为 2.4/10。疼痛评分增加与 MME 增加呈强相关（R = 0.78，P <.001）。多元线性回归确定，在 ESS 后 24 小时内，服用抗抑郁药的患者需要额外服用 17.2MME（95%置信区间[CI]：5.5-28.9，P =.004），而接受乳头状瘤切除术的患者需要额外服用 16.9MME（95% CI：2.5-31.4，P =.022）。
ESS 患者在术后即刻需要不同剂量的阿片类药物来控制疼痛。ESS 期间抗抑郁药的使用史和内翻性乳头状瘤切除术与术后阿片类药物消耗增加相关。
4 级喉镜，130：1122-1127，2020。
