Department of Surgery, Boston Children's Hospital, Boston, MA.
Department of Surgery, Boston Children's Hospital, Boston, MA.
J Am Coll Surg. 2020 Jun;230(6):944-946. doi: 10.1016/j.jamcollsurg.2020.03.023. Epub 2020 Apr 3.
Opiates are the traditional treatment for postoperative pain. Recognition that increased availability of opiates in the community is associated with increased addiction has led to efforts to decrease postoperative opiate distribution. However, there are concerns that without opiates, pain relief might be inadequate.
We analyzed opiate prescriptions to children who had undergone appendectomy during 3 time periods: before intervention (July 2012 through February 2013), after opiate prescriptions were standardized and reduced (December 2016 through December 2017), and after opiate prescriptions were eliminated (January 2018 through December 2018). We determined how many opiate prescriptions had been written and how many had been filled in each time period. Patients were contacted by phone to identify their medication use and quality of pain management.
Pre-intervention, 75 children underwent appendectomy, and all received opiate prescriptions, with a mean of 15 doses of oxycodone prescribed per patient. After reduction, 208 children underwent appendectomy and 30% received opiate prescriptions, for a mean of 1.5 doses of oxycodone per patient. After elimination, 270 patients underwent appendectomy and 3 patients (1.1%) received opiate prescriptions, for a mean of 0.05 doses of oxycodone per patient. Patients contacted by phone expressed no pain relief issues and no patients needed opiates later.
Using a stepwise process, we have eliminated the use of opiates for postdischarge pain in children undergoing laparoscopic appendectomy. This intervention has resulted in the elimination of 4,035 doses of oxycodone from the community during the study period, while ensuring that postoperative pain control has been adequate.
阿片类药物是治疗术后疼痛的传统方法。社区中阿片类药物供应增加与成瘾增加的认识促使人们努力减少术后阿片类药物的发放。然而，人们担心如果没有阿片类药物，疼痛缓解可能会不足。
我们分析了在 3 个时间段接受阑尾切除术的儿童的阿片类药物处方：干预前（2012 年 7 月至 2013 年 2 月）、阿片类药物处方标准化和减少后（2016 年 12 月至 2017 年 12 月）和阿片类药物处方消除后（2018 年 1 月至 2018 年 12 月）。我们确定了每个时间段开出和开出的阿片类药物处方数量。通过电话联系患者，以确定他们的用药情况和疼痛管理质量。
干预前，75 名儿童接受阑尾切除术，所有患者均开具阿片类药物处方，每位患者平均开具 15 剂羟考酮。减少后，208 名儿童接受阑尾切除术，30%的患者开具阿片类药物处方，每位患者平均开具 1.5 剂羟考酮。消除后，270 名儿童接受阑尾切除术，3 名患者（1.1%）开具阿片类药物处方，每位患者平均开具 0.05 剂羟考酮。通过电话联系的患者表示没有出现疼痛缓解问题，也没有患者以后需要阿片类药物。
通过逐步实施，我们已经消除了腹腔镜阑尾切除术后患儿使用阿片类药物进行出院后疼痛治疗。这一干预措施导致研究期间社区中减少了 4035 剂羟考酮的使用，同时确保术后疼痛控制是充分的。
