Division of Plastic & Reconstructive Surgery, 565745Baylor Scott & White Medical Center, TX, USA.
Cleft Palate Craniofac J. 2021 Dec;58(12):1500-1507. doi: 10.1177/1055665621990163. Epub 2021 Mar 10.
Currently, there is no consensus regarding the role of opioids in the management of perioperative pain in children undergoing cleft lip/palate repair.
The present study evaluated opioid prescribing patterns of surgeon members within the American Cleft Palate-Craniofacial Association surgeons utilizing an anonymous survey.
Respondents performing cleft lip repair typically operate on patients 3 to 6 months of age (86%), admit patients postoperatively (82%), and discharge them on the first postoperative day (72%). Comparatively, respondents performed palatoplasty between the ages of 10 and 12 months (62%), almost always admit the patients (99%), and typically discharge on the first postoperative day (78%). Narcotics were more frequently prescribed after palatoplasty than after cleft lip repair, both for inpatients (66%; 49%) and at discharge (38%; 22%). Oxycodone was the most prescribed narcotic (39.1%; 41.4%), typically for a duration of 1 to 3 days (81.5%; 81.2%). All surgeons who reported changing their narcotic regimen (34.4% dose, 32.8% duration) after cleft lip repair, decreased both parameters from earlier to later in their career. Similarly, surgeons who changed the dose (32.2%) and duration (42.5%) of narcotics after palatoplasty, mostly decreased both parameters (96%). Additionally, physicians with >15 years of practice were less likely to prescribe opioids in comparison with colleagues with ≤15 years of experience. Ninety-two percent of respondents endorsed prescribing nonopioid analgesics after prescribing cleft surgery, most commonly acetaminophen (85.7%; 85.4%).
Cleft surgeons typically prescribe opioids to inpatients and rarely upon discharge. Changes to opioid-prescribing patterns typically involved a decreased dose and duration.
目前，对于接受唇腭裂修复手术的儿童，围手术期疼痛管理中是否使用阿片类药物，尚无共识。
本研究通过匿名调查评估了美国颅面协会唇腭裂外科医生中外科医生的阿片类药物处方模式。
行唇裂修复术的受访者通常为 3 至 6 个月大的患者（86%）进行手术，术后接收患者（82%），并在术后第一天出院（72%）。相比之下，行腭裂修复术的受访者年龄在 10 至 12 个月（62%），几乎总是接收患者（99%），并通常在术后第一天出院（78%）。术后住院患者和出院患者使用的阿片类药物均多于唇裂修复术，分别为 66%（49%）和 38%（22%）。在腭裂修复术之后，阿片类药物的使用频率比唇裂修复术更高，包括术后住院患者（39.1%；41.4%）和出院患者（38%；22%）。最常开的阿片类药物为羟考酮（39.1%；41.4%），通常使用 1 至 3 天（81.5%；81.2%）。34.4%的医生改变了剂量，32.8%的医生改变了使用时长，他们都在职业生涯的早期和晚期减少了剂量和时长。同样，改变了剂量（32.2%）和使用时长（42.5%）的腭裂修复术外科医生，大多减少了这两个参数（96%）。此外，从业时间超过 15 年的医生比从业时间≤15 年的医生开具阿片类药物的可能性更小。92%的受访者表示，在开唇腭裂手术后会开非阿片类镇痛药，最常开的是对乙酰氨基酚（85.7%；85.4%）。
唇腭裂外科医生通常给住院患者开阿片类药物，很少在出院时开。阿片类药物处方模式的改变通常涉及剂量和使用时长的减少。
