Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA.
Division of Otolaryngology-Head and Neck Surgery, Santa Clara Valley Medical Center, San Jose, California, USA.
Otolaryngol Head Neck Surg. 2022 Oct;167(4):657-663. doi: 10.1177/01945998211071116. Epub 2022 Jan 11.
To evaluate the efficacy of implementing a standardized multimodal perioperative pain management protocol in reducing opioid prescriptions following otolaryngologic surgery.
Retrospective cohort study.
County hospital otolaryngology practice.
A perioperative pain management protocol was implemented in adults undergoing otolaryngologic surgery. This protocol included preoperative patient education and a postoperative multimodal pain regimen stratified by pain level: mild, intermediate, and high. Opioid prescriptions were compared between patient cohorts before and after protocol implementation. Patients in the pain protocol were surveyed regarding pain levels and opioid use.
We analyzed 210 patients (105 preprotocol and 105 postprotocol). Mean ± SD morphine milligram equivalents (MMEs) prescribed decreased from 132.5 ± 117.8 to 53.6 ± 63.9 ( < .05) following protocol implementation. Mean MMEs prescribed significantly decreased ( < .05) for each procedure pain tier: mild (107.4 to 40.5), intermediate (112.8 to 48.1), and high (240.4 to 105.0). Mean MMEs prescribed significantly decreased ( < .05) for each procedure type: endocrine (105.6 to 44.4), facial plastics (225.0 to 50.0), general (160.9 to 105.7), head and neck oncology (138.6 to 77.1), laryngology (53.8 to 12.5), otology (77.5 to 42.9), rhinology (142.2 to 44.4), and trauma (288.0 to 24.5). Protocol patients reported a mean 1-week postoperative pain score of 3.4, used opioids for a mean 3.1 days, and used only 39% of their prescribed opioids.
Preoperative counseling and standardization of a multimodal perioperative pain regimen for otolaryngology procedures can effectively lower amount of opioid prescriptions while maintaining low levels of postoperative pain.
评估实施标准化多模式围手术期疼痛管理方案对减少耳鼻喉科手术后阿片类药物处方的疗效。
回顾性队列研究。
县医院耳鼻喉科实践。
对接受耳鼻喉科手术的成人实施围手术期疼痛管理方案。该方案包括术前患者教育和术后多模式疼痛方案，根据疼痛程度分为轻度、中度和重度。比较方案实施前后患者队列的阿片类药物处方。对疼痛方案中的患者进行疼痛程度和阿片类药物使用情况调查。
我们分析了 210 例患者（105 例方案前和 105 例方案后）。方案实施后，处方的吗啡毫克当量（MME）均值±标准差从 132.5±117.8 降至 53.6±63.9（<0.05）。每个手术疼痛等级的 MME 处方均值均显著降低（<0.05）：轻度（107.4 至 40.5）、中度（112.8 至 48.1）和重度（240.4 至 105.0）。每种手术类型的 MME 处方均值均显著降低（<0.05）：内分泌（105.6 至 44.4）、面部整形（225.0 至 50.0）、普通（160.9 至 105.7）、头颈部肿瘤（138.6 至 77.1）、喉科（53.8 至 12.5）、耳科（77.5 至 42.9）、鼻科（142.2 至 44.4）和创伤（288.0 至 24.5）。方案患者报告术后 1 周平均疼痛评分为 3.4，使用阿片类药物平均 3.1 天，仅使用了处方阿片类药物的 39%。
耳鼻喉科手术的术前咨询和多模式围手术期疼痛方案的标准化可以有效降低阿片类药物处方量，同时保持低水平的术后疼痛。
