Miller Craig, Humphreys Ian M, Davis Greg E
Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, WA, USA.
Ann Otol Rhinol Laryngol. 2020 Jul;129(7):677-683. doi: 10.1177/0003489420906179. Epub 2020 Feb 6.
Management of pain following endoscopic sinus surgery (ESS) often involves intermittent use of opioid medications. Given the current opioid crisis, many surgeons aim to minimize opioid prescriptions. However, surgeons often avoid the use of NSAIDs following ESS out of concern for increased bleeding risk. We sought to evaluate the effectiveness and safety of over the counter dosing of ibuprofen on pain and bleeding rates following ESS.
Prospective cohort pilot study of patients undergoing ESS. Patients self-selected either control arm (acetaminophen and PRN oxycodone) or intervention arm (alternating ibuprofen with acetaminophen, and PRN oxycodone). Outcome measures included pain (10-point visual analog scale [VAS]), bleeding rate (10-point VAS), and number of opiate pills consumed.
Thirty-nine patients completed the study (15 control and 24 intervention). Overall, patients in the intervention arm reported decreased pain levels at days 1 (-0.9 [95%CI: -2.2, 0.5], 3 (-0.9 [95%CI: -2.3, 0.5]), and 7 (-0.6 [95%CI: -1.8, 0.6]), as well as decreased postoperative bleeding at those same days -0.9 [95%CI: -2.1, 0.4], -0.9 [95%CI: -2.1, 0.4], and -0.7 [95% CI: -1.2, -0.7], compared to controls. Opiate consumption was similar between groups with patients consuming on average four opiate pills (oxycodone 5 mg).
Over the counter dosing of ibuprofen along with acetaminophen may yield better pain control after sinus surgery compared to acetaminophen alone. Additionally, there was no significant difference in epistaxis in the ibuprofen cohort compared to the cohort who did not take ibuprofen. Furthermore, this study showed very few opioid pills were consumed after routine ESS regardless of pain regimen prescribed. A larger trial is needed to make definitive statements on safety and efficacy.
2b.
内镜鼻窦手术（ESS）后的疼痛管理通常涉及间歇性使用阿片类药物。鉴于当前的阿片类药物危机，许多外科医生旨在尽量减少阿片类药物的处方。然而，由于担心出血风险增加，外科医生在ESS后通常避免使用非甾体抗炎药（NSAIDs）。我们试图评估非处方剂量布洛芬对ESS后疼痛和出血率的有效性和安全性。
对接受ESS的患者进行前瞻性队列试点研究。患者自行选择对照组（对乙酰氨基酚和按需使用的羟考酮）或干预组（布洛芬与对乙酰氨基酚交替使用，以及按需使用的羟考酮）。结果指标包括疼痛（10分视觉模拟量表[VAS]）、出血率（10分VAS）和阿片剂的服用数量。
39名患者完成了研究（15名对照组和24名干预组）。总体而言，干预组患者在第1天（-0.9[95%CI：-2.2，0.5]）、第3天（-0.9[95%CI：-2.3，0.5]）和第7天（-0.6[95%CI：-1.8，0.6]）报告疼痛水平降低，并且在相同日期的术后出血也减少（分别为-0.9[95%CI：-2.1，0.4]、-0.9[95%CI：-2.1，0.4]和-0.7[95%CI：-1.2，-0.7]），与对照组相比。两组之间的阿片类药物消耗量相似，患者平均服用4片阿片剂（5毫克羟考酮）。
与单独使用对乙酰氨基酚相比，非处方剂量的布洛芬与对乙酰氨基酚联合使用可能在鼻窦手术后产生更好的疼痛控制效果。此外，布洛芬组与未服用布洛芬的组相比，鼻出血方面没有显著差异。此外，本研究表明，无论规定的疼痛治疗方案如何，常规ESS后服用的阿片剂都很少。需要进行更大规模的试验来对安全性和有效性做出明确的结论。
2b。
