Department of Otolaryngology - Head and Neck Surgery, New York Presbyterian Hospital - Weill Cornell Medicine, New York, NY, USA.
Department of Otolaryngology - Head and Neck Surgery, Fort Belvoir Community Hospital and Walter Reed National Military Medical Center, Fort Belvoir, VA, USA.
Am J Otolaryngol. 2020 Jul-Aug;41(4):102539. doi: 10.1016/j.amjoto.2020.102539. Epub 2020 May 11.
Judicious management of analgesics following rhinologic surgery is important for curtailing over-prescription of opioids. Limited data exists defining expected pain levels and appropriate opioid requirements after rhinologic surgery.
A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, Embase, Ovid MEDLINE, Cochrane Library databases were queried, and relevant articles were identified.
A total of 405 articles were identified, of which 13 met final inclusion criteria. Significant heterogeneity existed regarding type and quantity of opioid medication prescribed. Eight studies utilized a subjective patient-reported pain score as an outcome measure and reported mild to moderate postoperative pain that diminished over the first 3-6 days. Eight studies reported over-prescription of opioid medications with inappropriate storage of excess pills at home. Several factors were associated with an increased opioid requirement, including concurrent septoplasty, younger age, and current smoking status.
Rhinologic surgery is well tolerated with mild to moderate, short-lived postoperative pain. A limited amount and duration of opioid medications is required for routine management. Patients are frequently prescribed more opioids than is necessary for expected pain level, resulting in the potential for opioid misuse, abuse, and diversion. Current evidence is limited by a predominance of level 4 studies. Larger, higher quality studies with standardized reporting of pain score and opioid prescription quantity are needed.
鼻科学手术后合理管理镇痛药对于减少阿片类药物的过度处方至关重要。目前关于鼻科学手术后预期疼痛水平和适当阿片类药物需求的数据有限。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了系统评价。检索了 PubMed、Embase、Ovid MEDLINE、Cochrane 图书馆数据库，并确定了相关文章。
共确定了 405 篇文章，其中 13 篇符合最终纳入标准。在开具的阿片类药物的类型和数量方面存在显著的异质性。八项研究采用主观患者报告的疼痛评分作为结局测量指标，并报告了轻度至中度的术后疼痛，在第 3-6 天逐渐减轻。八项研究报告了阿片类药物的过度处方，在家中存在过多未使用的药丸储存不当的情况。一些因素与阿片类药物需求增加有关，包括同期鼻中隔成形术、年龄较小和当前吸烟状态。
鼻科学手术耐受良好，术后疼痛轻度至中度，持续时间短。常规管理只需少量和短时间的阿片类药物。患者经常被开具超过预期疼痛水平所需的阿片类药物，从而有可能导致阿片类药物滥用、误用和转移。目前的证据受到大量 4 级研究的限制。需要更大、更高质量的研究，标准化报告疼痛评分和阿片类药物处方数量。
