From the Department of Surgery, Division of Plastic Surgery, the John A. Burns School of Medicine, and the Department of Medicine, University of Hawaii; and the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco.
Plast Reconstr Surg. 2020 Feb;145(2):316e-323e. doi: 10.1097/PRS.0000000000006467.
Perioperative use of opioids is common in surgical practice and frequently results in troublesome opioid-related side effects that often lead to suboptimal postsurgical outcomes. As such, multiple studies have sought to identify alternatives that may reduce reliance on opioid-based perioperative pain management. Recently, it has been shown that patient education and patient involvement in care positively impact surgical outcomes. This study evaluates how patient education regarding the role of endogenous beta-endorphins in reducing pain and the opposing effect of opioid analgesics impacts opioid consumption and mood after surgery.
Patients scheduled for breast augmentation were divided into two groups, A and B. Both groups received identical multimodal anesthesia regimens; however, only patients in group B were educated on the role of endogenous beta-endorphins in pain control and mood enhancement, and how opioids block their action.
Patients in the group receiving preoperative education on the analgesic and mood-enhancing role of endogenous beta-endorphins and how opioids block their action consumed significantly less opioids and had better postsurgical outcomes as determined by self-reported measures of pain level and mood/sense of well-being.
The findings of this study suggest that opioid use was significantly reduced and patients' mood/sense of well-being was significantly enhanced when patients received preoperative education on the oppositional relationship between beta-endorphins and opioids. Such patient education may be linked to a significant reduction in opioid use and improved patient mood/sense of well-being, especially when combined with opioid-free multimodal anesthesia.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
围手术期使用阿片类药物在外科实践中很常见，常常导致令人困扰的阿片类药物相关副作用，这往往导致术后结果不理想。因此，多项研究试图寻找替代方法，以减少对基于阿片类药物的围手术期疼痛管理的依赖。最近，已经表明患者教育和患者参与护理对手术结果有积极影响。本研究评估了关于内源性β-内啡肽在减轻疼痛和阿片类镇痛药的相反作用方面的患者教育如何影响术后阿片类药物的消耗和情绪。
计划接受隆胸的患者分为两组，A 组和 B 组。两组均接受相同的多模式麻醉方案；然而，只有 B 组的患者接受了关于内源性β-内啡肽在疼痛控制和情绪增强中的作用以及阿片类药物如何阻断其作用的教育。
接受术前关于内源性β-内啡肽的镇痛和情绪增强作用以及阿片类药物如何阻断其作用的教育的患者消耗的阿片类药物明显减少，并且术后结果更好，自我报告的疼痛水平和情绪/幸福感的测量结果表明。
本研究的结果表明，当患者接受关于β-内啡肽和阿片类药物之间对立关系的术前教育时，阿片类药物的使用明显减少，患者的情绪/幸福感明显增强。这种患者教育可能与阿片类药物使用的显著减少和患者的情绪/幸福感的改善有关，尤其是与无阿片类药物的多模式麻醉相结合时。
临床问题/证据水平：治疗性，II 级。
