Thomas Jefferson University Hospital, Department of Otolaryngology - Head and Neck Surgery, 925 Chestnut St, Philadelphia, PA 19107, United States of America.
Thomas Jefferson University Hospital, Department of Otolaryngology - Head and Neck Surgery, 925 Chestnut St, Philadelphia, PA 19107, United States of America.
Am J Otolaryngol. 2022 Jan-Feb;43(1):103191. doi: 10.1016/j.amjoto.2021.103191. Epub 2021 Sep 2.
Evaluate opioid prescribing patterns, opioid consumption, and patient pain patterns following otologic surgery.
Patients were included if they were ≥18 years old and received otologic surgery between November 2019 and August 2020. Patients were provided a survey which included a visual analog scale for recording their pain postoperatively and the amount of opioid they had remaining. Patients who did not complete all portions of the survey were excluded.
Ninety-one patients completed the post-operative questionnaire. Collectively, patients were prescribed 5797 morphine milligram equivalents and used 3092: approximately 47% went unused. Of patients receiving a transcanal incision (n = 28/91, 31%), 70% went unused, whereas patients receiving a postauricular incision (n = 57/91, 63%), 38% went unutilized. The utilization difference between transcanal and postauricular cohorts was significant (p = 0.002). On multivariate analysis, patients who received a postauricular incision had 60% more opioid usage (p < 0.001), whereas those with a transcanal incision had an average reduction of 40% in opioid usage (p < 0.001).
A significant amount of opioid medication went unused in this study. Patients with postauricular incisions had significantly increased opioid utilization as compared to those with transcanal incisions. Otologists may be able to successfully manage pain in the postoperative period with a reduced opioid prescription multimodal analgesia and increased patient education. Further study is needed to support this suggestion.
评估耳科手术后的阿片类药物处方模式、阿片类药物消耗和患者疼痛模式。
纳入年龄≥18 岁且于 2019 年 11 月至 2020 年 8 月期间接受耳科手术的患者。患者接受问卷调查，包括术后疼痛的视觉模拟评分和剩余阿片类药物的数量。未完成调查所有部分的患者被排除在外。
91 名患者完成了术后问卷调查。总体而言，患者被开处了 5797 吗啡毫克当量，使用了 3092 毫克当量：约有 47%未使用。接受经耳道切口的患者（n=28/91，31%）中，有 70%未使用，而接受耳后切口的患者（n=57/91，63%）中，有 38%未使用。经耳道和耳后两组之间的使用差异具有统计学意义（p=0.002）。多变量分析显示，接受耳后切口的患者阿片类药物使用率增加了 60%（p<0.001），而接受经耳道切口的患者阿片类药物使用率平均减少了 40%（p<0.001）。
在这项研究中，大量阿片类药物未被使用。与经耳道切口的患者相比，接受耳后切口的患者阿片类药物的使用量显著增加。耳科医生可能能够通过减少阿片类药物处方、多模式镇痛和增加患者教育，成功管理术后疼痛。需要进一步的研究来支持这一建议。
