College of Medicine, The Ohio State University, Columbus, Ohio, USA.
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA.
Otolaryngol Head Neck Surg. 2019 Dec;161(6):960-966. doi: 10.1177/0194599819866823. Epub 2019 Jul 30.
Despite increased concern with the opioid epidemic, literature remains scant regarding narcotic prescription and use following tonsillectomy.
Retrospective cohort study with telephone interview.
A chart review from January to August 2018 evaluated the difference between prescribed amounts of narcotic and patient-reported usage following tonsillectomy ( codes 42821 and 42826). Patients were excluded if they used opioids for chronic pain, had a history of chronic opioid use or substance abuse, or underwent tonsillectomy to exclude malignancy. A telephone interview assessed opioid and nonopioid usage and pain control postoperatively, including amount and form of narcotics remaining.
Sixty-four patients were enrolled at a mean 4.47 months after tonsillectomy. The mean ± SD prescribed morphine milligram equivalent (MME) was 456.1 ± 281.7, with only 302.8 ± 206.2 consumed. The mean MME prescribed per day was 74.1 ± 44.8, and average days of narcotic usage postoperatively was 9.6 ± 4.6, correlating with a mean MME per day of 49.2 ± 34.3 if the maximum prescribed dose per day was consumed. Fifty-four (84.4%) patients reported pain as well controlled. Forty-three (67.2%) patients reported residual narcotic medication, with 228.1 ± 208.5 MMEs remaining per patient. Narcotic solutions were more completely consumed than tablet forms, with 23.1% and 44.0% remaining, respectively. Patients cited uncertainty about safe disposal and safeguarding for future use as reasons for keeping residual narcotic.
Patient-reported narcotic use is significantly lower than the amount prescribed after tonsillectomy for benign disease. Providers can use these data to adjust narcotic-prescribing patterns while maintaining appropriate pain management for patients undergoing tonsillectomy.
尽管人们对阿片类药物流行问题的关注日益增加，但有关扁桃体切除术后麻醉药物处方和使用的文献仍然很少。
回顾性队列研究并进行电话访谈。
2018 年 1 月至 8 月期间进行的图表回顾评估了扁桃体切除术后（代码 42821 和 42826）患者报告的麻醉药物使用量与处方量之间的差异。如果患者因慢性疼痛而使用阿片类药物、有慢性阿片类药物使用或药物滥用史，或因排除恶性肿瘤而接受扁桃体切除术，则将其排除在外。电话访谈评估了术后阿片类药物和非阿片类药物的使用情况和疼痛控制情况，包括剩余阿片类药物的数量和形式。
64 例患者在扁桃体切除术后平均 4.47 个月时入组。平均（±标准差）处方吗啡毫克当量（MME）为 456.1 ± 281.7，仅消耗 302.8 ± 206.2。平均每日 MME 处方量为 74.1 ± 44.8，术后使用麻醉药物的平均天数为 9.6 ± 4.6，如果每天最大剂量的麻醉药物都被使用，那么平均每日 MME 使用量为 49.2 ± 34.3。54 例（84.4%）患者报告疼痛得到了很好的控制。43 例（67.2%）患者报告剩余麻醉药物，每位患者剩余 MME 为 228.1 ± 208.5。麻醉药物溶液的消耗比片剂形式更完全，分别剩余 23.1%和 44.0%。患者表示，对安全处理和未来使用的安全性存疑是保留剩余麻醉药物的原因。
患者报告的麻醉药物使用量明显低于良性疾病扁桃体切除术后的处方量。提供者可以使用这些数据来调整麻醉药物的处方模式，同时为接受扁桃体切除术的患者提供适当的疼痛管理。
