Department of Otolaryngology, UCSF School of Medicine, San Francisco, California, USA.
Department of Otolaryngology, Mount Sinai Health, New York, New York, USA.
Otolaryngol Head Neck Surg. 2020 Jun;162(6):969-978. doi: 10.1177/0194599820915472. Epub 2020 Apr 14.
To evaluate postoperative opiate use and patients' opinions regarding pain management after endoscopic sinus surgery (ESS).
Case series with planned data collection.
Tertiary referral medical center.
We prospectively evaluated postoperative opiate utilization in adults undergoing ESS over a 2-year period at an academic medical facility. Exclusion criteria included use of nasal packing, intracranial or orbital procedures, tumor surgery, and any use of endoscopic drills. All patients underwent bilateral maxillary antrostomy, total ethmoidectomy, sphenoidotomy, and frontal sinusotomy with or without septoplasty. Patients were discharged with 30 oxycodone-acetaminophen (5-325 mg) and a survey assessing pain and narcotic/nonnarcotic use on postoperative days 0 to 7.
A total of 64 patients completed surveys. Mean ± SD narcotic use over the 7-day postoperative period was 7.7 ± 7.6 pills. Patients with high narcotic use (>6 pills total) had no differences in demographic or surgical factors from those with low use (≤6 pills) but did report a higher level of postoperative day 1 pain (4.8 ± 1.1 vs 2.0 ± 1.4, < .001). Narcotic use declined during this period, with <30% of patients requiring narcotics by postoperative day 3.
Our results support reduced opiate prescription and encouragement of nonnarcotic use after ESS without compromising effective pain management.
评估内镜鼻窦手术（ESS）后阿片类药物的使用情况和患者对疼痛管理的看法。
有计划数据收集的病例系列。
三级转诊医疗中心。
我们前瞻性地评估了在学术医疗设施中，2 年内接受 ESS 的成年人术后阿片类药物的使用情况。排除标准包括使用鼻填塞、颅内或眼眶手术、肿瘤手术以及任何使用内镜钻头。所有患者均行双侧上颌窦切开术、全筛窦切除术、蝶窦切开术和/或鼻中隔成形术。患者出院时携带 30 片羟考酮-对乙酰氨基酚（5-325 mg），并在术后第 0 至 7 天接受疼痛和阿片类/非阿片类药物使用情况的调查。
共有 64 名患者完成了调查。7 天术后期间平均（±标准差）阿片类药物使用量为 7.7 ± 7.6 片。高阿片类药物使用量（>6 片）的患者与低使用量（≤6 片）的患者在人口统计学或手术因素方面没有差异，但报告术后第 1 天的疼痛程度更高（4.8 ± 1.1 比 2.0 ± 1.4，<0.001）。在此期间，阿片类药物的使用量下降，<30%的患者在术后第 3 天需要使用阿片类药物。
我们的结果支持在不影响有效疼痛管理的情况下，减少 ESS 后的阿片类药物处方并鼓励使用非阿片类药物。
