Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Lebanon, New Hampshire.
St. Elizabeth's Medical Center, Boston, Massachusetts.
J Surg Res. 2020 Dec;256:564-569. doi: 10.1016/j.jss.2020.07.028. Epub 2020 Aug 14.
Surgery for anorectal disease is thought to cause significant postoperative pain. Our previous work demonstrated that most opioids prescribed after anorectal surgery are not used. We aimed to evaluate a standardized protocol for pain control after anorectal surgery.
We prospectively evaluated a standardized opioid reduction protocol over a 13-mo period for all patients undergoing elective anorectal surgery at our institution. Protocol components include preoperative query, procedural local-anesthetic blocks, first-line nonopioid analgesic use ± opioid prescription of five pills, and standardized postoperative instructions. Patients completed questionnaires at postoperative follow-up. Patients with history of opioid abuse or use within 30 d of operation, loss to follow-up, or surgical complications were excluded. Primary outcome was quality of pain control on a five-point scale. Secondary outcomes included use of nonopioid analgesics, opioids used, and need for refill.
A total of 55 patients were included. Mean age was 47 ± 17 y with 23 women (42%). Anorectal abscess/fistula procedures were the most common (69%) followed by pilonidal procedures (11%) and hemorrhoidectomy (7%). Most had general anesthesia (60%) with the remainder local anesthesia ± sedation. Fifty-four (98%) had procedural local-anesthetic blocks. Twenty-six patients (47%) were prescribed opioids with a median of five pills. Forty-seven patients (85%) reported the use of nonopioid analgesics. Forty-six patients (84%) reported excellent to very good pain control. About 220 opioid pills were prescribed, and 122 were reported to be used. One patient (2%) received an opioid refill.
Satisfactory pain control after anorectal surgery can be achieved with multimodality therapy with little to no opioid use for most patients.
肛门直肠疾病的手术被认为会引起明显的术后疼痛。我们之前的研究表明，大多数在肛门直肠手术后开的阿片类药物并未使用。我们旨在评估肛门直肠手术后疼痛控制的标准化方案。
我们前瞻性地评估了 13 个月期间在我们机构接受择期肛门直肠手术的所有患者的标准化阿片类药物减少方案。方案的组成部分包括术前查询、程序局部麻醉阻滞、一线非阿片类镇痛药的使用加/减阿片类药物处方五片，以及标准化的术后指导。患者在术后随访时完成问卷。排除有阿片类药物滥用史或手术前 30 天内使用阿片类药物、失访或手术并发症的患者。主要结果是五点疼痛控制质量评分。次要结果包括非阿片类镇痛药的使用、阿片类药物的使用和需要补开。
共纳入 55 例患者。平均年龄为 47 ± 17 岁，其中 23 例为女性（42%）。最常见的是肛门直肠脓肿/瘘管手术（69%），其次是藏毛窦手术（11%）和痔切除术（7%）。大多数患者采用全身麻醉（60%），其余采用局部麻醉加镇静。54 例（98%）进行了程序局部麻醉阻滞。26 例（47%）患者开具了阿片类药物处方，中位数为五片。47 例（85%）患者报告使用了非阿片类镇痛药。46 例（84%）患者报告疼痛控制极好至非常好。大约开出了 220 片阿片类药物，报告使用了 122 片。有 1 例（2%）患者需要补开阿片类药物。
大多数患者采用多模式治疗即可实现肛门直肠手术后的满意疼痛控制，几乎无需使用阿片类药物。
