Trauma Research Institute, Spectrum Health, Grand Rapids, USA.
Department of Surgery, Yale New Haven Hospital, New Haven, USA.
Surg Endosc. 2022 Nov;36(11):8472-8480. doi: 10.1007/s00464-022-09144-7. Epub 2022 Mar 4.
Post-operative prescription of opioids has fueled an increase in opioid-associated morbidity and mortality. Alternative post-operative pain control with non-opioid pharmaceuticals can help counteract this effect. We investigated a non-opioid pain management protocol following emergent laparoscopic appendectomy and laparoscopic cholecystectomy.
Our tertiary referral center performed a prospective observational feasibility study of patients from October 2019 to 2020 who underwent emergent laparoscopic appendectomies and cholecystectomies. Patients aged 18-65 with no prior history of chronic pain or opioid abuse, no contraindications to taking acetaminophen and ibuprofen, and Glomerular Filtration Rate > 60 ml/min were included. Counseling was provided about non-narcotic pain control. Patients were not prescribed narcotics at discharge and were instead prescribed ibuprofen and acetaminophen. Patients were surveyed at their 2-week post-operative appointment to assess pain control and other patient-reported outcomes, including quality of life (QOL).
Fifty-one patients met the inclusion criteria and completed the postoperative survey. Thirty-two were female (63%), average age 38, and BMI 30.4. 30 (59%) underwent laparoscopic appendectomy for acute non-perforated appendicitis and 21 (41%) underwent laparoscopic cholecystectomy for acute cholecystitis or symptomatic cholelithiasis. 88% of patients felt satisfied or neutral with their post-operative pain control at discharge. After 2 weeks, 34 patients (66.7%) rated QOL as high, 17 (33.3%) rated QOL as moderate, and none rated QOL as poor. Fascial suture was not associated with poor outcomes. Anxiety, depression, alcohol use, and prior abdominal surgery were not associated with increased need for post-operative narcotics. There were no significant differences between appendectomy and cholecystectomy in satisfaction with pain control or QOL (p > 0.05).
Patients undergoing surgery have an increased risk of developing an opioid disorder. The NOpioid Project demonstrated a non-narcotic multimodal pain regimen can be effectively adopted in the post-operative period after an emergent laparoscopic appendectomy or emergent laparoscopic cholecystectomy.
术后开具阿片类药物处方导致与阿片类药物相关的发病率和死亡率上升。使用非阿片类药物进行术后疼痛控制可以帮助抵消这种影响。我们研究了一种用于紧急腹腔镜阑尾切除术和腹腔镜胆囊切除术的非阿片类疼痛管理方案。
我们的三级转诊中心对 2019 年 10 月至 2020 年期间接受紧急腹腔镜阑尾切除术和胆囊切除术的患者进行了前瞻性观察性可行性研究。纳入标准为年龄 18-65 岁、无慢性疼痛或阿片类药物滥用史、无服用对乙酰氨基酚和布洛芬禁忌证且肾小球滤过率>60ml/min 的患者。对非阿片类药物止痛进行了咨询。患者在出院时未开具麻醉性镇痛药，而开具了布洛芬和对乙酰氨基酚。在术后 2 周时对患者进行调查，以评估疼痛控制和其他患者报告的结果，包括生活质量（QOL）。
51 例患者符合纳入标准并完成了术后调查。32 例为女性（63%），平均年龄 38 岁，BMI 为 30.4。30 例（59%）接受腹腔镜阑尾切除术治疗急性非穿孔性阑尾炎，21 例（41%）接受腹腔镜胆囊切除术治疗急性胆囊炎或有症状的胆石症。88%的患者对出院时的术后疼痛控制感到满意或中立。2 周后，34 例（66.7%）患者的生活质量评为高，17 例（33.3%）评为中，无一例评为差。筋膜缝合与不良结局无关。焦虑、抑郁、饮酒和既往腹部手术与术后对麻醉性镇痛药的需求增加无关。在疼痛控制或 QOL 满意度方面，阑尾切除术与胆囊切除术之间无显著差异（p>0.05）。
接受手术的患者有发生阿片类药物障碍的风险增加。NOpioid Project 表明，在紧急腹腔镜阑尾切除术或紧急腹腔镜胆囊切除术后的术后期间，可以有效地采用非麻醉性多模式疼痛治疗方案。
