Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Ann Surg Oncol. 2019 Oct;26(10):3295-3304. doi: 10.1245/s10434-019-07539-w. Epub 2019 Jul 24.
During the past 15 years, opioid-related overdose death rates for women have increased 471%. Many surgeons provide opioid prescriptions well in excess of what patients actually use. This study assessed a health systems intervention to control pain adequately while reducing opioid prescriptions in ambulatory breast surgery.
This prospective non-inferiority study included women 18-75 years of age undergoing elective ambulatory general surgical breast procedures. Pre- and postintervention groups were compared, separated by implementation of a multi-pronged, opioid-sparing strategy consisting of patient education, health care provider education and perioperative multimodal analgesic strategies. The primary outcome was average pain during the first 7 postoperative days on a numeric rating scale of 0-10. The secondary outcomes included medication use and prescription renewals.
The average pain during the first 7 postoperative days was non-inferior in the postintervention group despite a significant decrease in median oral morphine equivalents (OMEs) prescribed (2.0/10 [100 OMEs] pre-intervention vs 2.1/10 [50 OMEs] post-intervention; p = 0.40 [p < 0.001]). Only 39 (44%) of the 88 patients in the post-intervention group filled their rescue opioid prescription, and 8 (9%) of the 88 patients reported needing an opioid for additional pain not controlled with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) postoperatively. Prescription renewals did not change.
A standardized pain care bundle was effective in minimizing and even eliminating opioid use after elective ambulatory breast surgery while adequately controlling postoperative pain. The Standardization of Outpatient Procedure Narcotics (STOP Narcotics) initiative decreases unnecessary and unused opioid medication and may decrease risk of persistent opioid use. This initiative provides a framework for future analgesia guidelines in ambulatory breast surgery.
在过去的 15 年中，女性与阿片类药物相关的过量死亡率增加了 471%。许多外科医生开出的阿片类药物处方远远超过患者实际使用的量。本研究评估了一种卫生系统干预措施，旨在充分控制疼痛的同时减少门诊乳房手术中的阿片类药物处方。
本前瞻性非劣效性研究纳入了 18-75 岁接受择期门诊普通外科乳房手术的女性。比较了干预前和干预后两组，干预措施包括患者教育、医疗保健提供者教育和围手术期多模式镇痛策略。主要结局是术后第 7 天内的平均疼痛程度，采用数字评分量表（0-10 分）进行评估。次要结局包括药物使用和处方续开情况。
尽管术后中位口服吗啡等效剂量（OMEs）显著减少（干预前 2.0/10 [100 OMEs] 与干预后 2.1/10 [50 OMEs]；p=0.40 [p<0.001]），但术后第 7 天的平均疼痛仍无显著差异。在干预后组的 88 例患者中，只有 39 例（44%）患者开了急救阿片类药物处方，8 例（9%）患者报告术后需要阿片类药物来缓解非甾体抗炎药（NSAIDs）和对乙酰氨基酚无法控制的额外疼痛。处方续开情况未发生变化。
标准化疼痛护理包可有效减少甚至消除择期门诊乳房手术后的阿片类药物使用，同时充分控制术后疼痛。门诊手术阿片类药物规范化（STOP Narcotics）倡议减少了不必要和未使用的阿片类药物，并可能降低持续使用阿片类药物的风险。该倡议为门诊乳房手术的未来镇痛指南提供了框架。
