Kim Matthew, Kacker Ashutosh, Kutler David I, Tabaee Abtin, Stewart Michael G, Kjaer Klaus, Sclafani Anthony P
Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA.
Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA.
Otolaryngol Head Neck Surg. 2020 Dec;163(6):1178-1185. doi: 10.1177/0194599820933223. Epub 2020 Jul 14.
To quantify pain and opioid use after otorhinolaryngologic surgery. To determine the effect of patient and surgical factors on primary outcomes.
Prospective cohort.
Tertiary academic hospital.
Patients undergoing elective otorhinolaryngologic surgery were prospectively enrolled. Patients completed demographic surveys and psychometric questionnaires assessing attitudes toward pain and baseline anxiety and depression before surgery. After surgery, patients documented peak pain levels (0-100 mm, visual analog scale) and daily prescription and nonprescription analgesic requirements over a 2-week period. Average daily and cumulative pain and opioid use were calculated and compared among patient cohorts stratified by procedure and preoperative factors.
A total of 134 patients were enrolled. Total tonsillectomy was associated with significantly higher pain scores and opioid consumption, as compared to all other procedures. There was moderate correlation between average cumulative pain and opioid use. Older patients required significantly fewer doses of opioids. There was no effect of sex, marital status, or education level on postoperative pain or opioid use. Psychometric instrument scores and chronic pain or analgesic use were not associated with significant differences in pain or opioid requirements. Most patients were prescribed substantially more opioids than they actually required.
Postoperative pain following elective otorhinolaryngologic surgery decreases dramatically within the first week and requires only few days of opioid analgesia, with the exception of tonsillectomy. Almost all patients required fewer than 15 doses of opioids.
量化耳鼻咽喉科手术后的疼痛及阿片类药物使用情况。确定患者及手术因素对主要结局的影响。
前瞻性队列研究。
三级学术医院。
前瞻性纳入接受择期耳鼻咽喉科手术的患者。患者在手术前完成人口统计学调查及心理测量问卷，评估其对疼痛的态度以及基线焦虑和抑郁情况。术后，患者记录2周内的疼痛峰值水平（0 - 100毫米，视觉模拟量表）以及每日处方和非处方镇痛药需求。计算并比较按手术方式和术前因素分层的患者队列的平均每日及累积疼痛和阿片类药物使用情况。
共纳入134例患者。与所有其他手术相比，全扁桃体切除术的疼痛评分和阿片类药物消耗量显著更高。平均累积疼痛与阿片类药物使用之间存在中度相关性。老年患者所需阿片类药物剂量显著更少。性别、婚姻状况或教育水平对术后疼痛或阿片类药物使用无影响。心理测量工具评分以及慢性疼痛或镇痛药使用情况与疼痛或阿片类药物需求的显著差异无关。大多数患者所开具的阿片类药物远超其实际需求。
择期耳鼻咽喉科手术后的疼痛在第一周内会大幅减轻，除扁桃体切除术外，仅需几天的阿片类镇痛，几乎所有患者所需阿片类药物剂量少于15剂。
