From Howard University College of Medicine; Georgetown University; DAVinci Plastic Surgery; and Georgetown University School of Medicine.
Plast Reconstr Surg. 2021 Feb 1;147(2):325e-330e. doi: 10.1097/PRS.0000000000007592.
Prescription opioid misuse has been recognized as a national epidemic. The implications of this problem are especially important to consider, as postoperative opioid abuse can give rise to true addiction for surgical patients. The concept of enhanced recovery after surgery is increasingly used across various specialties to decrease the overabundance of postoperative opioid use.
This study prospectively examined 143 patients undergoing cosmetic elective surgery. Patients were randomized into one of two groups based on postoperative pain management regimen: multimodal (enhanced recovery after surgery) analgesia or traditional opioid analgesia. Data regarding postoperative pain scores, amount of postoperative opioids consumed, and duration of postoperative pain pill use were analyzed.
Multimodal (enhanced recovery after surgery) regimen patients experienced a 13.0 percent reduction in their pain scores after admission to the postanesthesia care unit and a 34.2 percent reduction in pain score at discharge, compared with traditional opioid patients (p = 0.049 and p = 0.0036, respectively). Enhanced recovery after surgery patients experienced a 35 percent reduction in the number of pills taken in the postoperative period and an 18.4 percent reduction in the duration of consumption (p = 0.0007 and p = 0.0539, respectively).
The results demonstrate that multimodal postoperative pain management is an important tool for decreasing the amount of opioids prescribed and needed in the postoperative period. The overprescribing of opioids after surgery is a precursor to abuse and the increase in the national opioid reservoir.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
处方类阿片类药物滥用已被视为一种全国性的流行疾病。考虑到术后阿片类药物滥用可能导致手术患者真正成瘾，这一问题的影响尤为重要。术后康复增强的概念越来越多地被应用于各个专业领域，以减少术后阿片类药物的过度使用。
本研究前瞻性地检查了 143 名接受美容择期手术的患者。根据术后疼痛管理方案，患者被随机分为两组：多模式（术后康复增强）镇痛或传统阿片类药物镇痛。分析了术后疼痛评分、术后阿片类药物消耗量和术后止痛药使用持续时间的数据。
与传统阿片类药物组相比，多模式（术后康复增强）方案组患者在进入麻醉后护理单元后的疼痛评分降低了 13.0%，出院时的疼痛评分降低了 34.2%（p=0.049 和 p=0.0036）。术后康复增强组患者在术后期间服用的药丸数量减少了 35%，消耗时间减少了 18.4%（p=0.0007 和 p=0.0539）。
研究结果表明，多模式术后疼痛管理是减少术后开具和所需阿片类药物数量的重要工具。术后阿片类药物的过度开具是滥用和国家阿片类药物储备增加的前兆。
临床问题/证据水平：治疗性，II 级。
