前瞻性随机试验比较术后门诊鼻整形术镇痛中阿片类药物与非甾体类抗炎药的效果。
Prospective Randomized Trial Comparing Opioids versus Nonsteroidal Antiinflammatory Drugs for Postoperative Analgesia in Outpatient Rhinoplasty.
机构信息
From the Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine; and the Department of Population Health, Division of Biostatistics, New York University Langone Health.
出版信息
Plast Reconstr Surg. 2021 Jan 1;147(1):56-62. doi: 10.1097/PRS.0000000000007427.
BACKGROUND
The misuse and abuse of opioids, including overprescription, has led to the current opioid epidemic and national crisis. There is a national effort to eliminate the unnecessary prescription of opioids for analgesia.
METHODS
Seventy patients were randomized to receive postoperative analgesia with either 5 mg hydrocodone with 325 mg acetaminophen (opioid control group) or 400 mg of ibuprofen [nonsteroidal antiinflammatory drug (NSAID) experimental group]. Pain levels were assessed on postoperative days 1, 2, and 7. Outcome measures included numeric pain rating scores and assessments of frequency and amount of analgesic used.
RESULTS
There was no significant difference in gender (p = 0.81) or age (p = 0.61) between groups. On postoperative day 0, the NSAID group (mean ± SD, 2.54 ± 1.57) was found to be noninferior to the opioid group (mean ± SD, 3.14 ± 1.75; p = 0.003). On postoperative day 1, the NSAID group showed a lower mean pain score (mean ± SD, 1.84 ± 1.29) than the opioid group (mean ± SD, 2.46 ± 1.90; p = 0.01). However, on postoperative day 7, the difference in pain scores between the NSAID (mean ± SD, 3.29 ± 2.14) and opioid (mean ± SD, 3.14 ± 2.12; p = 0.17) groups lost statistical significance. There was no significant difference in mean day of medication cessation between the NSAID (mean ± SD, 4.73 ± 1.57) and opioid (mean ± SD, 4.28 ± 2.23; p = 0.26) groups. Seventy-six percent of patients who were prescribed opioids took fewer than eight tablets. Five patients escalated from NSAIDs to opioids. There were no adverse effects related to NSAID use.
CONCLUSIONS
NSAIDs are an acceptable and safe alternative to opioids for postoperative analgesia in rhinoplasty and potentially lead to better overall pain control in some patients. Significantly reducing or eliminating opioid prescriptions may be considered in light of the current opioid epidemic.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
背景
阿片类药物的滥用和误用，包括过度处方，导致了当前的阿片类药物流行和全国性危机。全国上下正在努力消除不必要的阿片类药物用于镇痛。
方法
70 名患者被随机分配接受术后镇痛，分别使用 5 毫克氢可酮加 325 毫克对乙酰氨基酚（阿片类药物对照组）或 400 毫克布洛芬[非甾体抗炎药（NSAID）实验组]。在术后第 1、2 和 7 天评估疼痛程度。结果测量包括数字疼痛评分和评估使用的镇痛剂的频率和数量。
结果
两组在性别（p=0.81）或年龄（p=0.61）方面无显著差异。在术后第 0 天，NSAID 组（平均值±标准差，2.54±1.57）被发现与阿片类药物组（平均值±标准差，3.14±1.75；p=0.003）无差异。在术后第 1 天，NSAID 组的平均疼痛评分（平均值±标准差，1.84±1.29）低于阿片类药物组（平均值±标准差，2.46±1.90；p=0.01）。然而，在术后第 7 天，NSAID（平均值±标准差，3.29±2.14）和阿片类药物（平均值±标准差，3.14±2.12；p=0.17）组之间的疼痛评分差异失去了统计学意义。NSAID（平均值±标准差，4.73±1.57）和阿片类药物（平均值±标准差，4.28±2.23；p=0.26）组之间停止用药的平均天数无显著差异。开处阿片类药物的 76%患者服用的片剂少于 8 片。5 名患者从 NSAID 转为阿片类药物。无 NSAID 使用相关不良反应。
结论
在鼻整形术中，NSAIDs 是阿片类药物的一种可接受且安全的替代药物，可能在某些患者中导致更好的整体疼痛控制。鉴于当前的阿片类药物流行，可能会考虑显著减少或消除阿片类药物处方。
临床问题/证据水平：治疗性，II 级。
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