Columbia University Irving Medical Center, Department of Anesthesiology, New York, NY.
Columbia University Irving Medical Center, Department of Anesthesiology, New York, NY.
J Cardiothorac Vasc Anesth. 2021 Jun;35(6):1704-1711. doi: 10.1053/j.jvca.2020.12.021. Epub 2020 Dec 16.
OBJECTIVE(S): The authors aimed to assess whether the introduction of a tailored Analgesia Prescription Guideline would decrease the amount of unused opioid following discharge from cardiac surgery.
Prospective, observational, before and after study.
Quaternary care university hospital.
A total of 191 participants who underwent cardiac surgery requiring midline sternotomy and cardiopulmonary bypass. There were 99 participants in the before cohort (prior to introduction of the Analgesia Prescription Guideline), and 92 participants in the after cohort (after introduction of the Analgesia Prescription Guideline).
Using prospectively collected observational data on participant opioid consumption in the before cohort, a tailored Analgesia Prescription Guideline was developed. This guideline then was introduced to all opioid-prescribing providers in the cardiothoracic surgery department. Prospective data then were collected in the after cohort of participants. Opioid prescription practices and opioid consumption between the two groups then were compared.
Opioid prescriptions were given to 62/99 participants (63%) in the before cohort, and 48/92 (52%) in the after cohort (rate difference 0.1, CI 95% -0.26, 0.046). In the before cohort, the mean (± standard deviation) number of opioid tablets prescribed, used, and leftover was 26 (±10), 11 (±10), and 15 (±12), respectively. In the after cohort, the mean number of opioid tablets prescribed, used, and leftover was 18 (mean difference -8, CI 95% -12, -5), 10 (mean difference -1, CI 95% -5, 3), and 8 (mean difference -7, CI 95% -11, -3), respectively. There were 110/191 (58%) participants using no opioids following discharge, and 10/191 (5%) still using opioids two weeks after discharge. There were no differences between groups with regard to demographics, opioid-related side effects, pain scores, satisfaction, opioid storage. and disposal practices.
The development and implementation of a tailored Analgesia Prescription Guideline decreased the amount of opioids prescribed after cardiac surgery and resulted in lower numbers of unused leftover opioid tablets in the community. Patient comfort and satisfaction scores remained high.
作者旨在评估在心脏手术后引入量身定制的镇痛处方指南是否会减少出院后未使用的阿片类药物的数量。
前瞻性、观察性、前后研究。
四级保健大学医院。
总共 191 名接受过需要中线胸骨切开术和心肺旁路手术的心脏手术的参与者。前队列有 99 名参与者（在引入镇痛处方指南之前），后队列有 92 名参与者（在引入镇痛处方指南之后）。
在前队列中使用前瞻性收集的关于参与者阿片类药物消耗的观察数据，制定了量身定制的镇痛处方指南。然后，将该指南引入心胸外科部门的所有阿片类药物处方提供者。在后队列中前瞻性地收集参与者的数据。然后比较两组之间的阿片类药物处方实践和阿片类药物消耗。
在前队列中，62/99 名参与者（63%）开具了阿片类药物处方，在后队列中，48/92 名参与者（52%）开具了阿片类药物处方（率差 0.1，CI 95% -0.26，0.046）。在前队列中，开具的阿片类药物片剂数量、使用量和剩余量的平均值（±标准差）分别为 26（±10）、11（±10）和 15（±12）。在后队列中，开具的阿片类药物片剂数量、使用量和剩余量的平均值分别为 18（平均差异-8，CI 95% -12，-5）、10（平均差异-1，CI 95% -5，3）和 8（平均差异-7，CI 95% -11，-3）。出院后有 110/191 名（58%）参与者不再使用阿片类药物，有 10/191 名（5%）参与者在出院后两周仍在使用阿片类药物。两组在人口统计学、阿片类药物相关副作用、疼痛评分、满意度、阿片类药物储存和处理方面没有差异。
量身定制的镇痛处方指南的制定和实施减少了心脏手术后开具的阿片类药物数量，并导致社区中未使用的剩余阿片类药物片剂数量减少。患者舒适度和满意度评分仍然很高。
