Gill Kurren S, Chitguppi Chandala, Haggerty Michelle, Khoury Tawfiq, Fastenberg Judd, Nyquist Gurston, Toskala Elina, Rosen Marc, Rabinowitz Mindy
Department of Otolaryngology-Head & Neck Surgery Thomas Jefferson University Hospital Philadelphia Pennsylvania USA.
Laryngoscope Investig Otolaryngol. 2021 Jan 9;6(1):42-48. doi: 10.1002/lio2.519. eCollection 2021 Feb.
Pain and analgesic requirements after functional endoscopic sinus surgery (FESS) vary widely. This study aims to quantify pain after routine FESS and determine the most commonly used pain management regimen.
Retrospective chart review of 100 patients who underwent FESS from Oct 2017 to May 2019. Patients prospectively completed a daily pain diary and reported pain levels that were categorized into no pain (0), mild (1-3), moderate (4-7), or severe (8-10). Patients were categorized into narcotics, non-narcotics, combination, or none based on type of analgesic used.
Sixty-nine patients were included. Majority of patients reported either mild (39%) or no pain (28%) during the first 5 PODs. Mean POD1 pain score was 3.98, which decreased with each subsequent POD. On POD1, 37% used opioids (n = 37), 32% used non-opioids (n = 32), 22% used a combination (n = 22), and 9% used no pain meds (n = 9). Mean number of narcotic pills used within the first 5 PODs was 2 pills on any given day. Age was inversely associated with reported POD1 pain scores ( = .003) and use of preoperative steroids in patients with sinonasal polyposis was associated with lower POD1 pain scores ( = .03).
Even on POD1, majority of patients experienced either mild or no pain, and this decreases with each POD. Narcotics are grossly overprescribed and underutilized by patients postoperatively after FESS. We advocate for more judicious prescribing habits of narcotics by Otolaryngologists after FESS, and emphasize relying on non-narcotic alternatives like Acetaminophen or NSAIDS to diminish narcotic use and abuse in the postoperative period.
功能性鼻内镜鼻窦手术（FESS）后的疼痛及镇痛需求差异很大。本研究旨在量化常规FESS后的疼痛情况，并确定最常用的疼痛管理方案。
对2017年10月至2019年5月接受FESS的100例患者进行回顾性病历审查。患者前瞻性地完成每日疼痛日记，并报告疼痛程度，分为无痛（0）、轻度（1 - 3）、中度（4 - 7）或重度（8 - 10）。根据使用的镇痛药类型，将患者分为使用麻醉药、非麻醉药、联合用药或未用药组。
纳入69例患者。大多数患者在术后第1个5天内报告轻度疼痛（39%）或无痛（28%）。术后第1天的平均疼痛评分为3.98，随后每天逐渐降低。术后第1天，37%使用阿片类药物（n = 37），32%使用非阿片类药物（n = 32），22%联合用药（n = 22），9%未使用止痛药物（n = 9）。术后第1个5天内任何一天使用麻醉药的平均片数为2片。年龄与术后第1天报告的疼痛评分呈负相关（ = .003），鼻窦息肉患者术前使用类固醇与术后第1天较低的疼痛评分相关（ = .03）。
即使在术后第1天，大多数患者经历的是轻度疼痛或无痛，且随着术后天数增加疼痛减轻。FESS术后患者麻醉药存在严重的处方过度和使用不足的情况。我们提倡耳鼻喉科医生在FESS术后更明智地开具麻醉药处方，并强调依靠对乙酰氨基酚或非甾体抗炎药等非麻醉药替代品来减少术后麻醉药的使用和滥用。
4级。
