Department of Urology, University of California, San Diego, California, USA.
Department of Urology, Virginia Mason, Seattle, Washington, USA.
Can J Urol. 2021 Dec;28(6):10914-10919.
In an effort to decrease physician contribution to the opioid crisis, we utilized a narcotic free pathway (NFP) after urethroplasty. Our objectives were to demonstrate feasibility of a NFP and identify patients at higher risk for requiring postoperative narcotics.
We implemented a NFP for patients undergoing urethroplasty. Pain was assessed using the Likert scale (1-10). Narcotic use was quantified using oral morphine equivalents (OMEs).
Forty-six patients underwent urethroplasty following the NFP over a 7-month period. Fifteen patients were excluded, leaving 31 patients in the final analysis. Postintervention data was compared to 30 patients who underwent urethroplasty prior to implementation of the NFP. The groups had similar demographics except for a history of heroin abuse (0% preintervention, 12.9% postintervention, p = 0.04). Surgical characteristics were not statistically different aside from length of surgery (183.6 minutes preintervention, 145.5 minutes postintervention, p = 0.01). The mean [SD] perioperative OME use preintervention was 194.9 [151] mg, compared to 40.4 [111.9] mg postintervention (p < 0.001). Six patients postintervention were discharged with a narcotic prescription (mean 27.5 mg OME) compared to 26 patients preintervention (mean 76 mg OME) (p < 0.001). There was no difference in pain scores at any time interval. Patients with a history of chronic opioid use were more likely to require narcotics (OR 5.33, CI 1-28.44).
The narcotic free pathway resulted in a dramatic reduction in narcotic prescriptions without a significant difference in postoperative pain scores. Opioid use can be minimized following urethral and perineal surgery.
为了减少医生在阿片类药物危机中的贡献，我们在尿道成形术后采用了无麻醉剂途径（NFP）。我们的目标是证明 NFP 的可行性，并确定需要术后麻醉剂的患者的更高风险。
我们为接受尿道成形术的患者实施了 NFP。使用 Likert 量表（1-10）评估疼痛。使用口服吗啡当量（OME）量化麻醉剂的使用。
在 7 个月的时间里，有 46 名患者接受了 NFP 下的尿道成形术。排除了 15 名患者，最终分析中剩下 31 名患者。干预后数据与 30 名在实施 NFP 之前接受尿道成形术的患者进行了比较。两组的人口统计学特征相似，但海洛因滥用史不同（干预前为 0%，干预后为 12.9%，p=0.04）。手术特点除手术时间外无统计学差异（干预前为 183.6 分钟，干预后为 145.5 分钟，p=0.01）。干预前围手术期 OME 使用的平均值[标准差]为 194.9[151]mg，干预后为 40.4[111.9]mg（p<0.001）。干预后有 6 名患者出院时开了麻醉处方（平均 27.5mg OME），而干预前有 26 名患者（平均 76mg OME）（p<0.001）。在任何时间间隔都没有疼痛评分的差异。有慢性阿片类药物使用史的患者更有可能需要麻醉剂（OR 5.33，CI 1-28.44）。
无麻醉剂途径导致麻醉处方显著减少，而术后疼痛评分无显著差异。尿道和会阴手术后可以尽量减少阿片类药物的使用。
