Somers Kimberly K, Amin Ruchi, Leack Kathleen M, Lingongo Melissa, Arca Marjorie J, Gourlay David M
Children's Hospital of Wisconsin and Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Surg Open Sci. 2019 Oct 22;2(1):27-33. doi: 10.1016/j.sopen.2019.08.001. eCollection 2020 Jan.
Perioperative care after appendectomy may be the first exposure to opioids for many children. A quality improvement project was implemented to assess current practice of prescribing pain medications after a laparoscopic appendectomy to decrease unnecessary opioid use via simple, targeted steps.
Three measures were implemented in patients undergoing laparoscopic appendectomy for acute appendicitis: (1) ice packs to incision in postanesthesia care unit, (2) standard pain scores within 30 minutes of admission to ward postoperatively, and (3) standardized postoperative order set minimizing opioid utilization and limited number of opioids prescribed at discharge. Pre- and postimplementation data were compared with the primary outcome variable: opioid utilization during the postoperative period.
There were no statistically significant differences in age or gender between the 814 preimplementation and 263 postimplementation patients. Postimplementation compliance is 66.9% for icepacks, 88% for pain scores, and 94.7% for postoperative order set. There were statistically significant decreases in intravenous and enteral opioids administered, number of opioid doses prescribed at discharge, and patients discharged with an opioid prescription.
By using a multidisciplinary assessment of current state, culture, and management of parental, patient, and nursing expectations, our institution was able to reduce overall opioid consumption.
阑尾切除术后的围手术期护理可能是许多儿童首次接触阿片类药物。实施了一项质量改进项目，以评估腹腔镜阑尾切除术后开具止痛药物的当前做法，通过简单、有针对性的措施减少不必要的阿片类药物使用。
对因急性阑尾炎接受腹腔镜阑尾切除术的患者实施了三项措施：（1）在麻醉后护理单元对切口使用冰袋；（2）术后入住病房30分钟内的标准疼痛评分；（3）标准化的术后医嘱集，尽量减少阿片类药物的使用，并限制出院时开具的阿片类药物数量。将实施前后的数据与主要结局变量进行比较：术后期间的阿片类药物使用情况。
814例实施前患者和263例实施后患者在年龄或性别上无统计学显著差异。实施后冰袋使用的依从率为66.9%，疼痛评分的依从率为88%，术后医嘱集的依从率为94.7%。静脉和肠内给予的阿片类药物、出院时开具的阿片类药物剂量以及开具阿片类药物处方出院的患者数量均有统计学显著下降。
通过对当前状况、文化以及家长、患者和护理期望的管理进行多学科评估，我们机构能够减少总体阿片类药物的消耗。
