Jawad Basit A, Lam Kevin K, Cecola Colleen F, McCoul Edward D
Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA.
Department of Otorhinolaryngology and Communication Sciences, Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2022 Spring;22(1):15-21. doi: 10.31486/toj.21.0054.
Awareness of the opioid epidemic is promoting opioid stewardship in health care. For many commonly performed procedures in general surgery and gynecology, regimented opioid prescribing practices and/or multimodal nonopioid regimens are adequate for optimizing pain management and minimizing opioid dependence. We investigated opioid prescribing patterns for otolaryngology procedures at a tertiary hospital with the aim of characterizing postoperative pain and opioid use. This cross-sectional study with a patient survey was conducted in a tertiary care academic otolaryngology practice. Patients ≥18 years who underwent 1 of 41 common surgical procedures at an academic hospital between 2013 and 2017 were enrolled. Patients with any diagnosis of malignancy were excluded. Patients were analyzed according to surgery type (rhinoplasty, sinonasal surgery, tonsillectomy, parotidectomy, thyroidectomy, otologic surgery, and laryngoscopy), and those who had surgery in 2017 were surveyed via telephone interview using a standardized questionnaire. A total of 3,152 patients met the study criteria, of whom 95.7% received an opioid prescription. Commonly prescribed opioid agents were hydrocodone-acetaminophen, oxycodone-acetaminophen, and acetaminophen-codeine. A median of 30 pills was prescribed per surgery, with little variation between different surgery types. Reported patient utilization was highest for parotid surgery and tonsillectomy and lowest for laryngoscopic, thyroid, and otologic surgery. Among all patients who received a prescription for opioids, 5.8% required a refill. Among the surveyed patients, 19.6% reported that they did not obtain the prescribed opioid, while 58.4% said they took half, less than half, or none of the prescribed opioid supply. Only 10.8% of surveyed patients disposed of the excess drugs in a recommended fashion. Our findings showed that the quantity of opioid prescriptions does not reflect actual patient analgesic use for elective surgeries in otolaryngology. Differential analgesic requirements for specific surgeries should be considered when prescribing postoperative analgesia.
对阿片类药物流行情况的认识正在推动医疗保健领域的阿片类药物管理。对于普通外科和妇科中许多常见的手术，规范的阿片类药物处方做法和/或多模式非阿片类药物方案足以优化疼痛管理并最大限度地减少阿片类药物依赖。我们调查了一家三级医院耳鼻喉科手术的阿片类药物处方模式，目的是描述术后疼痛和阿片类药物使用情况。这项带有患者调查的横断面研究在一家三级医疗学术耳鼻喉科诊所进行。纳入了2013年至2017年期间在一家学术医院接受41种常见外科手术之一的18岁及以上患者。排除任何患有恶性肿瘤诊断的患者。根据手术类型（隆鼻术、鼻窦手术、扁桃体切除术、腮腺切除术、甲状腺切除术、耳科手术和喉镜检查）对患者进行分析，并且通过电话访谈使用标准化问卷对2017年接受手术的患者进行了调查。共有3152名患者符合研究标准，其中95.7%接受了阿片类药物处方。常用的阿片类药物制剂有氢可酮-对乙酰氨基酚、羟考酮-对乙酰氨基酚和对乙酰氨基酚-可待因。每次手术处方的阿片类药物中位数为30片，不同手术类型之间差异不大。腮腺手术和扁桃体切除术的患者报告使用率最高，而喉镜检查、甲状腺和耳科手术的使用率最低。在所有接受阿片类药物处方的患者中，5.8%需要重新配药。在接受调查的患者中，19.6%报告说他们没有拿到处方的阿片类药物，而58.4%说他们服用了一半、不到一半或没有服用处方的阿片类药物供应量。只有10.8%的接受调查患者以推荐方式处理了多余的药物。我们的研究结果表明，阿片类药物处方量并不能反映耳鼻喉科择期手术患者的实际镇痛药物使用情况。在开具术后镇痛药物时应考虑特定手术的不同镇痛需求。
