Turcotte Bruno, Jacques Emma, Tremblay Samuel, Toren Paul, Caumartin Yves, Lodde Michele
Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada.
Can Urol Assoc J. 2022 Aug;16(8):E432-E436. doi: 10.5489/cuaj.7633.
Recent literature emphasizes how overprescription and lack of guidelines contribute to wide variation in opioid prescribing practices and opioid-related harms. We conducted a prospective, observational study to evaluate opioid prescriptions among uro-oncologic patients discharged following elective in-patient surgery.
Patients who underwent four surgeries were included: open retropubic radical prostatectomy, robot-assisted radical prostatectomy, laparoscopic radical nephrectomy, and laparoscopic partial nephrectomy. The primary outcome was the dose of opioids used after discharge (in oral morphine equivalents [MEq]). Secondary outcomes included: opioid requirements for 80% of the patients, management of unused opioids, opioid use three months postoperative, opioid prescription refills, and guidance about opioid disposal.
Sixty patients were included for analysis. Patients used a mean of 30 MEq (95% confidence interval 17.8-42.2) at home and 80% of the patients used 50 MEq or less. A mean of 40.4 MEq per patient was overprescribed. Fifty percent of the patients kept the remaining opioids at home, with only 20.0% returning them to their pharmacy. After three months, 5.0% of the patients were using opioids at least occasionally. Three patients needed a new opioid prescription. Forty percent reported having received information regarding management of unused opioids.
We found 60% of opioids prescribed were unused, with half of our patients keeping these unused tablets at home. Our results suggest appropriate opioid prescription amounts needed for urological cancer surgery, with 80% of the patients using 50 MEq or less of morphine equivalents.
近期文献强调了过度处方和缺乏指南如何导致阿片类药物处方实践的广泛差异以及与阿片类药物相关的危害。我们进行了一项前瞻性观察性研究，以评估择期住院手术后出院的泌尿肿瘤患者的阿片类药物处方情况。
纳入接受四种手术的患者：开放性耻骨后根治性前列腺切除术、机器人辅助根治性前列腺切除术、腹腔镜根治性肾切除术和腹腔镜部分肾切除术。主要结局是出院后使用的阿片类药物剂量（以口服吗啡当量[MEq]计）。次要结局包括：80%患者的阿片类药物需求量、未使用阿片类药物的处理、术后三个月的阿片类药物使用情况、阿片类药物处方 refill 情况以及阿片类药物处置指导。
纳入 60 例患者进行分析。患者在家平均使用 30 MEq（95%置信区间 17.8 - 42.2），80%的患者使用量为 50 MEq 或更少。每位患者平均被过度处方 40.4 MEq。50%的患者将剩余阿片类药物留在家中，只有 20.0%的患者将其返还给药房。三个月后, 5.0%的患者至少偶尔使用阿片类药物。三名患者需要新的阿片类药物处方。40%的患者报告收到过关于未使用阿片类药物处理的信息。
我们发现 60%的阿片类药物处方未被使用，一半患者将这些未使用的药片留在家中。我们的结果表明泌尿外科癌症手术所需的阿片类药物处方量应适当，80%的患者使用 50 MEq 或更少的吗啡当量。
