Yale University School of Medicine, New Haven, CT.
Yale University School of Medicine, New Haven, CT.
J Pediatr Surg. 2020 Jan;55(1):106-111. doi: 10.1016/j.jpedsurg.2019.09.063. Epub 2019 Oct 26.
BACKGROUND/PURPOSE: Surgeon overprescription of opioids is a modifiable contributor to the opioid epidemic. No clear guidelines exist for prescribing opioids to younger patients after surgery. We sought to determine postoperative opioid needs in pediatric/young adult patients after laparoscopic appendectomy.
Patients 5-20 years old who underwent laparoscopic appendectomy were included for study. All consented patients underwent chart review and were additionally called for an attempted interview. Caregivers were queried on analgesic use and adequacy of pain relief. The main outcome measures were: quantity of opioid used, desire for an opioid, presence of pain ≥4/10, and need for follow-up/call owing to pain. All opioids were converted into morphine milligram equivalents (MME).
Seventy-three patients qualified for the study, 49 of whom completed a postoperative telephone interview. Of the interviewees, 83% did not use or desire an opioid and reported pain <4/10 after discharge. Five patients used an opioid upon discharge, and the average MME consumed was 23 (equivalent to 3 pills of 5 mg oxycodone). No zero-opioid patients had unanticipated follow-up for pain concerns.
After hospital discharge following laparoscopic appendectomy, most patients have adequate analgesia without opioids. Opioid prescriptions should be offered sparingly and for no more than 25 MME.
Level II.
Prognosis study.
背景/目的：外科医生过度开具阿片类药物是导致阿片类药物流行的一个可改变的因素。目前尚没有明确的指南指导外科医生为接受手术后的年轻患者开具阿片类药物。我们旨在确定腹腔镜阑尾切除术后儿科/年轻成年患者的术后阿片类药物需求。
纳入年龄在 5-20 岁接受腹腔镜阑尾切除术的患者进行研究。所有同意参与研究的患者均接受病历回顾，并进行了电话随访尝试。询问了照顾者的镇痛药物使用情况和疼痛缓解的充分性。主要观察指标为：使用的阿片类药物数量、对阿片类药物的需求、疼痛≥4/10 的存在以及因疼痛需要随访/电话咨询的情况。所有阿片类药物均转换为吗啡毫克当量（MME）。
73 名患者符合研究条件，其中 49 名完成了术后电话访谈。在接受访谈的患者中，83%的患者未使用或需要阿片类药物，出院后报告疼痛<4/10。5 名患者出院时使用了阿片类药物，平均 MME 消耗量为 23（相当于 5mg 羟考酮 3 片）。没有使用零阿片类药物的患者因疼痛问题需要意外随访。
腹腔镜阑尾切除术后出院后，大多数患者无需阿片类药物即可获得足够的镇痛效果。阿片类药物的处方应谨慎开具，且不超过 25 MME。
Ⅱ级；研究类型：预后研究。
