Patzkowski Michael S, Hammond Kevin L, Herrera Germaine, Highland Krista B
Department of Anesthesiology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA.
Mil Med. 2023 Jan 4;188(1-2):e339-e342. doi: 10.1093/milmed/usab263.
Guidelines indicate the need to balance the risks of opioid prescribing with the need to adequately manage pain after cesarean section (CS). Although guidelines suggest the need for tailored opioid prescribing, it is unclear whether providers currently tailor opioid prescribing practices given patient-related factors. Thus, research is needed to first understand post-CS pain management and opioid prescribing. The objective of the present study was to identify factors related to CS discharge opioid prescriptions.
This retrospective cohort study was approved by the Brooke Army Medical Center Institutional Review Board (San Antonio, Texas; #C.2020.094e) on June 23, 2020. Electronic health record data of healthy adult women undergoing primary elective CS, performed under regional neuraxial anesthesia at a single, academic, tertiary medical center from 2018 to 2019, were included. Multivariable regression examined patient and medical factors associated with post-CS opioid prescriptions.
In the present sample (N = 169), 23% (n = 39) of patients did not use opioids postoperatively, while inpatient and almost all of those patients (n = 36) received a discharge prescription for opioids with a median amount of 225 morphine milligram equivalent doses. There was a lack of evidence indicating that patient and medical factors were associated with discharge opioid dose.
Patient and medical factors were not associated with post-CS opioid prescribing. Larger studies are needed to better elucidate optimal post-CS pain management in the days and months that follow CS. Such findings are needed to better tailor opioid prescribing, consistent with clinical practice guidelines.
指南指出，在剖宫产术后（CS）充分管理疼痛的需求与开具阿片类药物的风险之间需要取得平衡。尽管指南建议需要根据具体情况开具阿片类药物，但目前尚不清楚医疗服务提供者是否会根据患者相关因素调整阿片类药物的处方做法。因此，首先需要开展研究以了解剖宫产术后的疼痛管理和阿片类药物处方情况。本研究的目的是确定与剖宫产术后出院时阿片类药物处方相关的因素。
这项回顾性队列研究于2020年6月23日获得布鲁克陆军医疗中心机构审查委员会（德克萨斯州圣安东尼奥；#C.2020.094e）批准。纳入了2018年至2019年在一家单一的学术性三级医疗中心接受区域神经轴索麻醉下进行初次择期剖宫产的健康成年女性的电子健康记录数据。多变量回归分析了与剖宫产术后阿片类药物处方相关的患者和医疗因素。
在本样本（N = 169）中，23%（n = 39）的患者术后未使用阿片类药物，而住院患者中几乎所有这些患者（n = 36）出院时都收到了阿片类药物处方，中位数剂量为225毫克吗啡当量。缺乏证据表明患者和医疗因素与出院时阿片类药物剂量有关。
患者和医疗因素与剖宫产术后阿片类药物处方无关。需要开展更大规模的研究，以更好地阐明剖宫产术后数天和数月内的最佳疼痛管理方法。需要这样的研究结果来更好地根据临床实践指南调整阿片类药物的处方。
