Long Emily A, Johnson Shepard P, Valmadrid Al, Wormer Blair A, Drolet Brian C, Perdikis Galen
From the Vanderbilt University School of Medicine.
Departments of Plastic Surgery.
Ann Plast Surg. 2020 Jun;84(6S Suppl 5):S437-S440. doi: 10.1097/SAP.0000000000002268.
The opioid epidemic is a healthcare crisis perpetuated by analgesic overprescribing. Despite public health attention on this issue, expectations for pain management and opioid use by plastic surgery patients are poorly understood. This study aimed to evaluate patient expectations of postoperative pain, concern for opioid dependence, and anticipated analgesic plan after plastic surgery.
New patients presenting to an academic plastic surgery clinic were prospectively enrolled from November 2017 to September 2018. These patients completed a preconsultation survey regarding their pain history and anticipated postoperative pain and analgesics regimens. Responses between cohorts expecting and not expecting postoperative opioids were compared using descriptive and univariate analyses.
A total of 168 patients (63.9% female, 36.1% male; mean ± SD age 46 ± 17 years) completed the survey before breast (21.9%), cosmetic (5.3%), craniofacial (3.0%), general reconstruction (13.0%), hand (3.0%), and skin and soft tissue (49.1%) surgeries. Twenty-eight percent of patients expected opioid prescriptions. On a standard visual analog scale, patients who expected opioids anticipated greater postoperative pain (6.9 vs 4.6, P < 0.05). They were more concerned about experiencing pain (5.8 vs 4.9, P < 0.05), expected a longer duration of opioid use (63.0% vs 37.0%, P < 0.05), and were less interested in nonnarcotic analgesic alternatives (57.9% vs 19.8%, P < 0.05).
Less than one-third of plastic surgery patients in this study expect opioid pain medications after surgery. This supports broader use of nonopioid, multimodal pain regimens. Identification and management of patient pain expectations, especially among those anticipating a need for opioids, provide a critical opportunity for preoperative education on the benefits of nonopioid analgesics, thus minimizing opiate prescribing.
阿片类药物泛滥是由镇痛药过度处方导致的医疗危机。尽管公众健康领域对该问题予以关注，但整形手术患者对疼痛管理及阿片类药物使用的期望仍知之甚少。本研究旨在评估整形手术患者对术后疼痛的期望、对阿片类药物依赖的担忧以及预期的镇痛方案。
2017年11月至2018年9月，前瞻性纳入在一家学术性整形手术诊所就诊的新患者。这些患者完成了一项术前调查，内容涉及他们的疼痛史以及预期的术后疼痛和镇痛方案。使用描述性和单变量分析比较预期和不预期术后使用阿片类药物的队列之间的反应。
共有168例患者（63.9%为女性，36.1%为男性；平均±标准差年龄46±17岁）在接受乳房（21.9%）、美容（5.3%）、颅面（3.0%）、一般重建（13.0%）、手部（3.0%）以及皮肤和软组织（49.1%）手术前完成了调查。28%的患者预期会开具阿片类药物处方。在标准视觉模拟量表上，预期使用阿片类药物的患者预计术后疼痛更剧烈（6.9对4.6，P<0.05）。他们更担心疼痛（5.8对4.9，P<0.05），预期阿片类药物使用时间更长（63.0%对37.0%，P<0.05），并且对非麻醉性镇痛替代方案兴趣较低（57.9%对19.8%，P<0.05）。
本研究中不到三分之一的整形手术患者预期术后会使用阿片类镇痛药。这支持更广泛地使用非阿片类多模式镇痛方案。识别和管理患者的疼痛期望，尤其是在那些预期需要使用阿片类药物的患者中，为术前开展关于非阿片类镇痛药益处的教育提供了关键契机，从而尽量减少阿片类药物的处方。
