Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Ann Surg Oncol. 2021 Oct;28(11):5855-5864. doi: 10.1245/s10434-021-09963-3. Epub 2021 Jun 2.
We sought to determine if lumpectomy patients who received perioperative opioid-sparing multimodal analgesia reported less pain when compared with those who received traditional opioid-based care.
A prospective cohort of patients undergoing lumpectomy who received an opioid-sparing multimodal analgesia protocol [no opioids group (NOP)] was compared with a large cohort of patients who received traditional care [opioids group (OG)]. In-hospital and discharge opioids were compared using oral morphine equivalents (OMEs). Postoperative day one and week one pain scores were compared using the Kruskal-Wallis test.
Overall, 1153 patients underwent lumpectomy: 634 patients received the protocol (NOP), and 519 patients did not (OG). Median pain scores were significantly lower in the NOP cohort when compared with the OG cohort the day after surgery (2 vs. 0, p < 0.001) and the week after surgery (1 vs. 0, p < 0.001). NOP patients were significantly less likely to report severe pain (7-10 on a 10-point scale) the day after surgery compared with OG patients (15.7% vs. 6.9%, p = 0.004). Patients in the NOP cohort were discharged with a median of zero OMEs (range 0-150), while patients in the OG were discharged with a median of 90 OMEs (range 0-360; p < 0.001).
Implementation of an opioid-sparing multimodal analgesia protocol for lumpectomy patients resulted in superior pain control without a routine opioid prescription. Surgeons can improve their own patients' outcomes while addressing the larger societal issue of the opioid crisis by adopting similar protocols that decrease the quantity of opioids available for diversion.
我们旨在确定与接受传统阿片类药物为基础的治疗的患者相比，接受围手术期阿片类药物节约多模式镇痛的保乳术患者报告的疼痛是否更少。
前瞻性队列研究了接受阿片类药物节约多模式镇痛方案（无阿片组[NOP]）的保乳术患者，并与接受传统治疗的大量患者（阿片组[OG]）进行了比较。使用口服吗啡等效物（OME）比较住院和出院时的阿片类药物。使用 Kruskal-Wallis 检验比较术后第 1 天和第 1 周的疼痛评分。
共有 1153 例患者接受了保乳术：634 例患者接受了该方案（NOP），519 例患者未接受（OG）。与 OG 组相比，NOP 组患者术后第 1 天和第 1 周的中位数疼痛评分明显较低（分别为 2 分和 0 分，p < 0.001）。与 OG 组相比，NOP 组患者术后第 1 天报告严重疼痛（10 分制 7-10 分）的可能性明显较低（15.7%比 6.9%，p = 0.004）。NOP 组患者出院时 OME 中位数为零（范围 0-150），而 OG 组患者出院时 OME 中位数为 90（范围 0-360；p < 0.001）。
为保乳术患者实施阿片类药物节约多模式镇痛方案可实现更好的疼痛控制，而无需常规阿片类药物处方。外科医生可以通过采用类似的减少阿片类药物可获得性的方案来改善自己患者的预后，同时解决阿片类药物危机这一更大的社会问题。
