Medical University of South Carolina - Florence Medical Center, Florence, SC.
Wellstar Kennestone Hospital, Marietta, GA.
Perm J. 2020 Dec;25:1-3. doi: 10.7812/TPP/20.048.
Perioperative pain management guidelines recommend using multimodal analgesia to improve pain control while reducing opioids administered. The primary objective of this study was to assess whether implementing multimodal analgesia on general surgery postoperative pain management order sets would reduce opioid quantities postoperatively.
Opioid-naive patients undergoing nonemergent general surgery procedures were evaluated before and after order set revision. The primary outcome was the total quantity of inpatient opioids administered. The secondary outcomes were inpatient naloxone administration, patient-reported pain scores, and opioid quantities prescribed at discharge.
The average daily opioid consumption was less each postoperative day (POD) after implementing the revised postsurgical multimodal analgesia pain management order set. On POD 1 and POD 2, average opioid consumption was 53.6 and 47.9 oral morphine equivalents (OME) before the multimodal analgesia order set, respectively, compared with 21.2 and 21.4 OME after, respectively (p < 0.01 and p < 0.01, respectively). Average daily opioid consumption through POD 3 was 60.6 OME before and 21.14 OME after the revision. Average daily pain scores were similar on POD 0, 1, and 2 before and after (3.2, 2.8, and 2.4 compared with 2.8, 3.1, and 2.7, respectively; p = 0.09, 0.33, and 0.12, respectively). On POD 3, pain scores were higher in the postorder set group (2.8 compared with 1.9; p < 0.01), but this was considered clinically insignificant. Average daily pain score through POD 3 was 2.6 before implementation compared with 2.8 after implementation. Neither group required naloxone administration.
Using perioperative multimodal analgesia reduces opioid consumption without increasing pain scores.
围手术期疼痛管理指南建议使用多模式镇痛来改善疼痛控制，同时减少给予的阿片类药物。本研究的主要目的是评估在普通外科术后疼痛管理医嘱集上实施多模式镇痛是否会减少术后阿片类药物的用量。
评估术前和术后医嘱集修订后接受非紧急普通外科手术的阿片类药物初治患者。主要结局是给予的住院阿片类药物总量。次要结局是住院期间纳洛酮的使用、患者报告的疼痛评分和出院时开的阿片类药物量。
实施修订后的术后多模式镇痛疼痛管理医嘱集后，每天的阿片类药物消耗量在每个术后日（POD）都有所减少。在 POD1 和 POD2，分别在实施多模式镇痛医嘱集之前，平均阿片类药物消耗量为 53.6 和 47.9 口服吗啡当量（OME），而分别在实施之后为 21.2 和 21.4 OME（p<0.01 和 p<0.01）。在修订后的 POD3，阿片类药物消耗量为每天 60.6 OME，而在修订前为每天 60.6 OME。在 POD0、1 和 2，无论修订前后，平均每日疼痛评分相似（分别为 3.2、2.8 和 2.4 与 2.8、3.1 和 2.7；p=0.09、0.33 和 0.12）。在 POD3，术后医嘱集组的疼痛评分较高（2.8 与 1.9；p<0.01），但这被认为是临床意义不大的。在实施之前，平均每日疼痛评分通过 POD3 为 2.6，而在实施之后为 2.8。两组均未使用纳洛酮。
使用围手术期多模式镇痛可减少阿片类药物的消耗，而不会增加疼痛评分。
