Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas.
J Surg Oncol. 2022 Mar;125(4):719-729. doi: 10.1002/jso.26768. Epub 2021 Dec 14.
Opioids are commonly prescribed following surgery and can lead to persistent opioid use. We assessed changes in prescribing practices following an opioid education initiative for patients undergoing lymphadenectomy for cutaneous malignancy.
A single-institution retrospective study of all eligible patients (3/2016-3/2020) was performed.
Indications for lymphadenectomy in 328 patients were metastatic melanoma (84%), squamous cell carcinoma (10%), and Merkel cell carcinoma (5%). At discharge, non-opioid analgesics were increasingly utilized over the 4-year study period, with dramatic increases after education initiatives (32%, 42%, 59%, and 79% of pts, respectively each year; p < 0.001). Median oral morphine equivalents (OMEs) prescribed also decreased dramatically starting in year 3 (250, 238, 150, and 100 mg, respectively; p < 0.001). Patients discharged with 200 mg OMEs were less likely to also be discharged with non-opioid analgesics (40% vs. 64%. respectively, p < 0.001).
Analgesic prescribing practices following lymphadenectomy for cutaneous malignancy improved significantly over a 4-year period, with use of non-opioids more than doubling and a 60% reduction in median OME. Opportunities exist to further increase non-opioid use and decrease opioid dissemination after lymphadenectomy for cutaneous malignancy.
手术后常开具阿片类药物，可导致持续使用阿片类药物。我们评估了针对皮肤恶性肿瘤行淋巴结切除术患者的阿片类药物教育计划实施后处方实践的变化。
对所有符合条件的患者（2016 年 3 月至 2020 年 3 月）进行了一项单机构回顾性研究。
328 例患者行淋巴结切除术的适应证为转移性黑色素瘤（84%）、鳞状细胞癌（10%）和 Merkel 细胞癌（5%）。在出院时，非阿片类镇痛药在 4 年研究期间被越来越多地使用，在教育计划实施后出现显著增加（分别为每年 32%、42%、59%和 79%的患者；p<0.001）。开具的口服吗啡当量（OME）中位数也从第 3 年开始显著下降（分别为 250、238、150 和 100mg；p<0.001）。出院时 OME 为 200mg 的患者更不可能同时开具非阿片类镇痛药（分别为 40%和 64%；p<0.001）。
在皮肤恶性肿瘤行淋巴结切除术的 4 年内，镇痛处方实践显著改善，非阿片类药物的使用率增加了一倍以上，OME 的中位数降低了 60%。在皮肤恶性肿瘤行淋巴结切除术之后，有机会进一步增加非阿片类药物的使用并减少阿片类药物的传播。
