Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA.
Otolaryngol Head Neck Surg. 2020 May;162(5):746-753. doi: 10.1177/0194599820912033. Epub 2020 Mar 24.
To examine whether a service guideline reducing postoperative opioid prescription quantities and caregiver-reported education to use nonopioid analgesics first are associated with caregiver-reported pain control after pediatric tonsillectomy.
Prospective cohort study (July 2018-April 2019).
Pediatric otolaryngology service at a tertiary academic children's hospital.
Caregivers of patients aged 1 to 11 years undergoing tonsillectomy (N = 764) were surveyed 7 to 21 days after surgery regarding pain control, education to use nonopioid analgesics first, and opioid use. Respondents who were not prescribed opioids or had missing data were excluded. Logistic regression modeled caregiver-reported pain control as a function of service guideline implementation (December 2018) recommending 20 rather than 30 doses for postoperative opioid prescriptions and caregiver-reported analgesic education, adjusting for patient demographics.
Among 430 respondents (56% response), 387 patients were included. The sample was 43% female with a mean age of 5.0 years (SD, 2.5). Pain control was reported as good (226 respondents, 58%) or adequate/poor (161 respondents, 42%). Mean opioid prescription quantity was 27 doses (SD, 7.9) before and 21 doses (SD, 6.1) after guideline implementation ( < .001). Education to use nonopioids first was reported by 308 respondents (80%). In regression, prescribing guideline implementation was not associated with pain control (adjusted odds ratio, 1.3; 95% CI, 0.9-2.0; = .22), but caregiver-reported education to use nonopioids first was associated with a higher odds of good pain control (adjusted odds ratio, 1.9; 95% CI, 1.1-3.2; = .02).
Caregiver education to use nonopioid analgesics first may be a modifiable health care practice to improve pain control as postoperative opioid prescription quantities are reduced.
研究减少术后阿片类药物处方数量和向护理人员提供使用非阿片类镇痛药的教育指导，这一服务准则是否与小儿扁桃体切除术后护理人员报告的疼痛控制有关。
前瞻性队列研究（2018 年 7 月至 2019 年 4 月）。
一家三级学术儿童医院的儿科耳鼻喉科服务。
在手术后 7 至 21 天，对 764 名年龄在 1 至 11 岁之间接受扁桃体切除术的患者的护理人员进行了疼痛控制、使用非阿片类镇痛药的教育指导和阿片类药物使用情况的调查。排除未开具阿片类药物或数据缺失的患者。采用 logistic 回归模型，将护理人员报告的疼痛控制情况作为术后阿片类药物处方数量（20 剂而不是 30 剂）和护理人员报告的镇痛教育指导实施服务指南（2018 年 12 月）的函数，同时调整患者的人口统计学特征。
在 430 名应答者（56%的应答率）中，有 387 名患者纳入分析。样本中女性占 43%，平均年龄为 5.0 岁（标准差[SD]，2.5）。疼痛控制报告为良好（226 名应答者，58%）或足够/差（161 名应答者，42%）。指南实施前阿片类药物处方数量平均为 27 剂（SD，7.9），实施后为 21 剂（SD，6.1）（<.001）。308 名应答者（80%）报告接受了使用非阿片类药物的教育指导。在回归分析中，处方指南的实施与疼痛控制无关（调整后的优势比，1.3；95%CI，0.9-2.0；=.22），但护理人员报告使用非阿片类药物的教育指导与良好疼痛控制的几率更高相关（调整后的优势比，1.9；95%CI，1.1-3.2；=.02）。
减少术后阿片类药物处方数量的同时，向护理人员提供使用非阿片类镇痛药的教育指导，可能是改善疼痛控制的一种可改变的医疗保健实践。
