Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Head Neck. 2021 May;43(5):1545-1552. doi: 10.1002/hed.26617. Epub 2021 Jan 27.
Opioid abuse is widespread in the United States and the risk for chronic use is increased in surgical patients, including patients with thyroid and parathyroid.
Records for 171 patients prior to and 67 patients following implementation of an enhanced recovery after surgery (ERAS) protocol for ambulatory thyroid/parathyroid surgeries were reviewed. The ERAS included superficial cervical plexus block, multimodal premedication, and postoperative reliance on acetaminophen and ibuprofen with judicious prescribing of opioids.
Post-ERAS patients were prescribed a mean 72 morphine milligram equivalents (MME); pre-ERAS patients were prescribed a mean 163 MME (p < 0.001). 97.1% of pre-ERAS patients were prescribed opioids with 91.1% filled; 68.7% of post-ERAS study patients were prescribed opioids with 84.8% filled.
Implementation of ERAS and focus on prescribing practices decreased the MME prescribed and used for ambulatory thyroid and parathyroid surgery. Future steps include increased patient education and tracking pain scores and medication utilization out of hospital.
阿片类药物滥用在美国普遍存在，手术患者（包括甲状腺和甲状旁腺患者）慢性使用的风险增加。
回顾了 171 例接受增强术后恢复（ERAS）方案的门诊甲状腺/甲状旁腺手术患者和 67 例接受 ERAS 方案前的患者的记录。ERAS 方案包括浅表颈丛阻滞、多模式预用药以及术后依赖对乙酰氨基酚和布洛芬，并谨慎开具阿片类药物。
ERAS 后患者平均开具 72 吗啡毫克当量（MME）；ERAS 前患者平均开具 163 MME（p < 0.001）。97.1%的 ERAS 前患者开具了阿片类药物，其中 91.1%的患者完成了处方；68.7%的 ERAS 研究患者开具了阿片类药物，其中 84.8%的患者完成了处方。
实施 ERAS 并关注处方实践减少了门诊甲状腺和甲状旁腺手术中开具和使用的 MME。未来的步骤包括增加患者教育和跟踪出院后疼痛评分和药物使用情况。
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