Institute of Urology, University of Southern California, Los Angeles, CA, USA.
Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Andrologia. 2020 Jun;52(5):e13563. doi: 10.1111/and.13563. Epub 2020 Mar 20.
Routine prescription of opioids after outpatient surgery is common. The main objective of this study was to determine urologist opioid prescribing patterns and patients' pain control medication regimens (opioid and anti-inflammatory) after vasectomy. We designed an anonymous seven-question electronic survey of urologists to assess vasectomy practice and post-vasectomy opioid prescriptions using the American Medical Association Physician Masterfile database. We then performed a retrospective internal telephone survey of men who had undergone vasectomy by a single surgeon (MKS). This telephone survey queried men about opioid prescription filling, opioid use and ibuprofen use. We received 136 (4.5%) electronic survey responses. 51.5% of urologists routinely prescribed opioids for post-vasectomy analgesia, despite 50.4% having 'no idea' how many patients actually used these. On internal telephone survey, 52.6% of patients who used opioids reported using ibuprofen as their primary pain medication, versus 92.6% of patients who did not use opioids (p = .004). Ibuprofen use was associated with using fewer opioid tablets (p = .003). Using ≥1 opioid tab was associated with increased odds of not using ibuprofen as the primary pain medication (OR 11.2, 95% CI 2.39-83.0, p = .005). In conclusion, integration of practice guidelines may help standardise and minimise potentially unnecessary post-vasectomy opioid prescriptions.
常规开具阿片类药物处方用于门诊手术后很常见。本研究的主要目的是确定泌尿科医生在输精管切除术后开具阿片类药物的处方模式和患者的疼痛控制药物方案（阿片类药物和抗炎药）。我们设计了一项针对泌尿科医生的匿名七项电子调查，使用美国医学协会医师主文件数据库评估输精管切除术实践和输精管切除术后阿片类药物处方。然后，我们对一位外科医生（MKS）进行的输精管切除术的男性患者进行了回顾性内部电话调查。这项电话调查询问了男性关于阿片类药物处方填写、阿片类药物使用和布洛芬使用的情况。我们收到了 136 份（4.5%）电子调查回复。尽管 50.4%的医生“不知道”有多少患者实际使用了这些药物，但仍有 51.5%的泌尿科医生常规开具阿片类药物用于输精管切除术后镇痛。在内部电话调查中，52.6%使用阿片类药物的患者报告说将布洛芬作为主要止痛药，而未使用阿片类药物的患者中这一比例为 92.6%（p=0.004）。布洛芬的使用与使用较少的阿片类药物片数相关（p=0.003）。使用≥1 片阿片类药物与不使用布洛芬作为主要疼痛药物的可能性增加相关（OR 11.2，95%CI 2.39-83.0，p=0.005）。总之，整合实践指南可能有助于规范和最小化潜在的不必要的输精管切除术后阿片类药物处方。
