Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada.
Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.
Int J Gynecol Cancer. 2021 Dec;31(12):1584-1588. doi: 10.1136/ijgc-2021-002968. Epub 2021 Nov 8.
Opioids are routinely prescribed after minimally invasive gynecologic oncology surgery, with minimal data to inform the ideal dose. The aim of this study was to evaluate the impact of a restrictive opioid prescription protocol on the median morphine milligram equivalents prescribed and pain control in patients undergoing minimally invasive surgery.
A restrictive opioid prescription protocol was implemented from January through December 2020 at a single tertiary cancer center in Ontario, Canada. Consecutive patients undergoing minimally invasive hysterectomy for suspected malignancy were included. Simultaneously, we implemented use of multimodal analgesia, patient and provider education, pre-printed standardized prescriptions, and tracking of opioid prescriptions. Total median morphine milligram equivalents prescribed were compared between pre- and post-intervention cohorts. Patients were surveyed regarding opioid use and pain control at 30 days post-surgery.
A total of 101 women in the post-intervention cohort were compared with 92 consecutive pre-intervention controls. Following protocol implementation, median morphine milligram equivalents prescribed decreased from 50 (range 9-100) to 25 (range 8-75) (p<0.001). In the post-intervention cohort, 75% (76/101) used 10 median morphine milligram equivalents or less and 55 patients (54%) used 0 median morphine milligram equivalent. There was no additional increase in opioid refill requests after implementation of our strategy. Overall, patients reported a median pain score of 3/10 at 30 days post-surgery; the highest pain scores and most of the pain occurred in the first week after surgery.
Implementation of a restrictive opioid prescription protocol led to a significant reduction in opioid use after minimally invasive gynecologic oncology surgery, with over 50% of patients requiring no opioids postoperatively.
在微创妇科肿瘤手术后，常规开具阿片类药物，但很少有数据可以指导理想的剂量。本研究旨在评估限制阿片类药物处方方案对接受微创手术患者的处方吗啡毫克当量中位数和疼痛控制的影响。
2020 年 1 月至 12 月，在加拿大安大略省的一家单一的三级癌症中心实施了一项限制阿片类药物处方方案。纳入接受微创子宫切除术治疗疑似恶性肿瘤的连续患者。同时，我们实施了多模式镇痛、患者和提供者教育、预印标准化处方以及阿片类药物处方跟踪。比较干预前后队列中总中位数吗啡毫克当量的处方。术后 30 天对患者进行阿片类药物使用和疼痛控制调查。
在干预后队列中共有 101 名女性与 92 名连续的干预前对照进行比较。方案实施后，中位数吗啡毫克当量的处方量从 50（范围 9-100）降至 25（范围 8-75）（p<0.001）。在干预后队列中，75%（76/101）使用 10 中位数吗啡毫克当量或更少，55 名患者（54%）使用 0 中位数吗啡毫克当量。在实施我们的策略后，阿片类药物续开请求没有增加。总体而言，患者术后 30 天报告的中位数疼痛评分为 3/10；最高的疼痛评分和大部分疼痛发生在手术后的第一周。
实施限制阿片类药物处方方案后，微创妇科肿瘤手术后阿片类药物的使用显著减少，超过 50%的患者术后无需使用阿片类药物。
