Huynh Victoria, Rojas Kristin, Ahrendt Gretchen, Murphy Colleen, Jaiswal Kshama, Cumbler Ethan, Christian Nicole, Tevis Sarah
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Department of Surgery, Maimonides Medical Center, Brooklyn, New York.
J Surg Res. 2020 Oct;254:232-241. doi: 10.1016/j.jss.2020.04.030. Epub 2020 May 28.
This study aims to assess multimodal pain management and opioid prescribing practices in patients undergoing breast surgery.
A retrospective review of patients undergoing breast surgery at an academic medical center between April 1, 2018 and September 30, 2019, was performed. Patients with a history of recent opioid use or conditions precluding use of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (APAP) were excluded. Opioid-sparing pain regimens were assessed. Opioids prescribed on discharge were recorded as oral morphine equivalents (OMEs) and concordance with the Opioid Prescribing Engagement Network (OPEN) determined.
The total study population consisted of 518 patients. 358 patients underwent minor outpatient procedures (sentinel lymph node biopsy, lumpectomy, and excisional biopsy), 10-40% of whom were appropriately prescribed as per the OPEN. Perioperatively, 53.9% of patients received APAP, 24.6% NSAIDs, 20.4% gabapentin, and 0.3% blocks; intraoperatively, 95.8% received local anesthetic and 25.7% ketorolac. For mastectomy without reconstruction, 63-88% of prescriptions were concordant with the OPEN. For mastectomy with reconstruction, discharge opioids ranged from 25 to 400 OMEs with a mean of 134.4 OMEs; 25% of patients received a refill. Of all patients undergoing mastectomy ± reconstruction, 62.5% received APAP, 18.8% NSAIDs, 38.8% pregabalin, and 20.6% locoregional block perioperatively; 37.5% received local anesthetic and 15.6% ketorolac intraoperatively. Of 143 inpatient stays, 89% received APAP, 38% NSAID, and 29% benzodiazepines; 29 patients received no opioids inpatient but were still prescribed 25-200 OMEs on discharge.
There is need for a multidisciplinary approach to pain management with the use of enhanced recovery after surgery protocols as potential means to standardize perioperative regimens and mitigate opioid overprescription.
本研究旨在评估接受乳房手术患者的多模式疼痛管理及阿片类药物处方实践。
对2018年4月1日至2019年9月30日在一家学术医疗中心接受乳房手术的患者进行回顾性研究。排除近期有阿片类药物使用史或存在妨碍使用非甾体抗炎药（NSAIDs）或对乙酰氨基酚（APAP）情况的患者。评估阿片类药物节省疼痛方案。出院时开具的阿片类药物记录为口服吗啡当量（OMEs），并确定与阿片类药物处方参与网络（OPEN）的一致性。
研究总人群包括518例患者。358例患者接受了小型门诊手术（前哨淋巴结活检、乳房肿瘤切除术和切除活检），其中10 - 40%的患者根据OPEN得到了适当的处方。围手术期，53.9%的患者接受了APAP，24.6%接受了NSAIDs，20.4%接受了加巴喷丁，0.3%接受了阻滞；术中，95.8%的患者接受了局部麻醉，25.7%接受了酮咯酸。对于未进行重建的乳房切除术，63 - 88%的处方与OPEN一致。对于进行重建的乳房切除术，出院时的阿片类药物剂量为25至400 OMEs，平均为134.4 OMEs；25%的患者接受了续方。在所有接受乳房切除术±重建的患者中，62.5%在围手术期接受了APAP，18.8%接受了NSAIDs，38.8%接受了普瑞巴林，20.6%接受了局部区域阻滞；37.5%在术中接受了局部麻醉，15.6%接受了酮咯酸。在143次住院病例中，89%的患者接受了APAP，38%接受了NSAID，29%接受了苯二氮䓬类药物；29例患者住院期间未接受阿片类药物，但出院时仍被开具25 - 200 OMEs的药物。
需要采用多学科方法进行疼痛管理，将术后加速康复方案作为标准化围手术期方案和减轻阿片类药物过度处方的潜在手段。
