Hall Bradley R, Billue Katherine L, Hon Heidi, Sanders Stacey E, Barrientos Stephan, Flores Laura E, Nicholas Thomas, Shostrom Valerie, Meyer Bria, Johnson Perry J
Department of Surgery, University of Nebraska Medical Center, Omaha, Nebr.
Department of Plastic and Reconstructive Surgery, University of Nebraska Medical Center, Omaha, Nebr.
Plast Reconstr Surg Glob Open. 2020 Dec 21;8(12):e3305. doi: 10.1097/GOX.0000000000003305. eCollection 2020 Dec.
From a public health perspective, nasal surgery accounts for many unused opioids. Patients undergoing septorhinoplasty require few opioids, and efforts to eliminate this need may benefit both patients and the public.
A multimodal analgesic protocol consisting of 15 components encompassing all phases of care was implemented for 42 patients.
Median age and BMI were 34 years and 23, respectively. Most were women (79%), White (79%), primary surgeries (62%), and self-pay (52%). Comorbid conditions were present in 74% of the patients, with anxiety (33%) and depression (21%) being the most common. Septoplasties (67%) and osteotomies (45%) were common. The median operative time was 70 minutes. No patients required opioids in recovery, and median time in recovery was 63 minutes. Ten (24%) patients required an opioid prescription after discharge. In those patients, median time to requirement was 27 hours (range 3-81), and median total requirement was 20 mg morphine equivalents (range 7.5-85). Protocol compliance inversely correlated to opioid use ( = 0.007). Compliance with local and regional anesthetic (20% versus 63%, = 0.030) as well as ketorolac (70% versus 100%, = 0.011) was lower in patients who required opioids. Patients who required opioids were less likely to be administered a beta blocker (0% versus 34%, = 0.041). Pain scores were higher in opioid users on postoperative days 1-5 ( < 0.05). No complications occurred in those requiring opioids, and satisfaction rates were equivalent between groups.
This protocol allowed us to safely omit opioid prescriptions in 76% of patients following septorhinoplasty, without adverse effects on outcomes or patient satisfaction.
从公共卫生角度来看，鼻部手术导致了许多阿片类药物的未使用。接受鼻中隔成形术的患者所需阿片类药物较少，消除这种需求的努力可能对患者和公众都有益。
对42例患者实施了包含15个涵盖护理各阶段组成部分的多模式镇痛方案。
中位年龄和体重指数分别为34岁和23。大多数为女性（79%）、白人（79%）、初次手术（62%）和自费（52%）。74%的患者存在合并症，最常见的是焦虑（33%）和抑郁（21%）。鼻中隔成形术（67%）和截骨术（45%）很常见。中位手术时间为70分钟。恢复期间无患者需要阿片类药物，中位恢复时间为63分钟。10例（24%）患者出院后需要阿片类药物处方。在这些患者中，中位需求时间为27小时（范围3 - 81小时），中位总需求量为20毫克吗啡当量（范围7.5 - 85毫克）。方案依从性与阿片类药物使用呈负相关（P = 0.007）。需要阿片类药物的患者对局部和区域麻醉的依从性（20%对63%，P = 0.030）以及酮咯酸的依从性（70%对100%，P = 0.011）较低。需要阿片类药物的患者接受β受体阻滞剂治疗的可能性较小（0%对34%，P = 0.041）。术后1 - 5天阿片类药物使用者的疼痛评分较高（P < 0.05）。需要阿片类药物的患者未发生并发症，两组的满意度相当。
该方案使我们能够在76%的鼻中隔成形术后患者中安全地省略阿片类药物处方，且对结局或患者满意度无不良影响。
