Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine.
Stanford Ear Institute, Stanford, California.
Otol Neurotol. 2019 Oct;40(9):1194-1198. doi: 10.1097/MAO.0000000000002364.
To prospectively evaluate opioid consumption following adult outpatient otologic surgery.
Prospective observational.
Single-tertiary referral center.
Patients scheduled for otologic surgery who did not have a history of chronic opioid use were recruited between February 2018 and February 2019.
Opioid consumption was queried using telephone or in-person surveys administered between postoperative days 5 and 15. Patient demographics, surgical details, and opioid prescription patterns were abstracted from medical records. Opioid distribution was determined by querying records maintained by the California Department of Justice through a state-wide prescription drug monitoring program mandated since 2016.
Seventy patients were prescribed an average of 68.9 ± 31.8 mg of morphine equivalents (MME) and consumed 47.3 ± 42.9 MME over 2.4 ± 2.3 days postoperatively. Patients who received a postauricular incision were prescribed significantly more than those who underwent transcanal procedures (86.2 vs 55.9 MME; t test, p < 0.001), consumed significantly more (72.2 vs 28.6 MME; t test, p < 0.001), and for a significantly longer duration (3.4 vs 1.6 days; t test, p = 0.001). In the postauricular group, there was no significant difference in consumption between mastoidectomy and nonmastoidectomy subgroups (64.9 vs 89.2 MME; t test, p = 0.151). Eighty percent of transcanal patients consumed 50 MME (10 pills) or less, while 80% of postauricular patients consumed 80 MME (16 pills) or less.
Patients in our cohort consumed approximately 3/4 of the prescribed opioids. Those with postauricular incisions used significantly more than those with transcanal incisions. Postoperative opioid prescription recommendations should be tailored according to the extent of surgery.
前瞻性评估成人门诊耳科学手术后阿片类药物的使用情况。
前瞻性观察。
单三级转诊中心。
2018 年 2 月至 2019 年 2 月期间招募了计划接受耳科学手术且无慢性阿片类药物使用史的患者。
术后 5 至 15 天通过电话或面对面调查询问阿片类药物的使用情况。从病历中提取患者人口统计学、手术细节和阿片类药物处方模式。通过查询自 2016 年以来全州范围内的处方药物监测计划（由加利福尼亚州司法部维护的记录）确定阿片类药物的分布情况。
70 名患者平均开处方 68.9±31.8mg 吗啡等效物（MME），术后 2.4±2.3 天内消耗 47.3±42.9 MME。接受耳后入路的患者开的处方明显多于经耳道入路的患者（86.2 比 55.9 MME；t 检验，p<0.001），消耗的也明显更多（72.2 比 28.6 MME；t 检验，p<0.001），且时间明显更长（3.4 比 1.6 天；t 检验，p=0.001）。在耳后组中，乳突切除术和非乳突切除术亚组之间的消耗没有显著差异（64.9 比 89.2 MME；t 检验，p=0.151）。80%的经耳道患者消耗 50 MME（10 片）或更少的阿片类药物，而 80%的耳后患者消耗 80 MME（16 片）或更少的阿片类药物。
我们队列中的患者大约消耗了处方阿片类药物的 3/4。耳后入路的患者使用量明显多于经耳道入路的患者。应根据手术范围调整术后阿片类药物处方建议。
