Division of Urology, Albany Medical College, Albany, New York.
Department of Surgery, Albany Medical College, Albany, New York.
J Urol. 2022 May;207(5):969-981. doi: 10.1097/JU.0000000000002447. Epub 2022 Apr 8.
Opioid prescriptions after surgery are major contributors to the opioid abuse epidemic. Several measures designed to limit opioid prescriptions at discharge have been evaluated. We conducted a comprehensive review and meta-analysis of the effectiveness of various types of interventions in reducing opioid prescriptions after urological surgery.
A systematic review including MEDLINE®, Web of Science™ and Cochrane databases was conducted to identify studies on opioid prescriptions and urological surgery. Twenty-two studies met the inclusion criteria, of which 19 were used for quantitative analysis for reduction in opioid prescriptions. Additional outcomes included opioid consumption and satisfaction with analgesia.
Of the 8,318 patients, 53% were in the pre- and 47% in the post-intervention cohort. Overall mean reduction/patient in prescribed opioids was -67.59 (95% CI 54.23 to 80.94) morphine milligram equivalents (MME). Direct interventions, implemented by providers within their local department or hospital, were more effective in reducing prescribed opioids compared to indirect, or systemic, interventions, at -76.68 MME (95% CI 60.04 to -93.31) vs -46.72 MME (95% CI 24.20 to -69.23; p=0.04). Opioid consumption significantly decreased post-intervention with a mean reduction of -18.31 MME (95% CI 7.89 to 28.72). Patient satisfaction with analgesia remained unchanged between the pre- and post-intervention groups.
Successful reduction in opioid prescriptions, without compromising pain control, can be achieved through a variety of interventions. Direct interventions appear to have a greater impact than indirect interventions in reducing opioid prescriptions. Despite the reduction, unused, excess prescription opioids were still noted, which provides an opportunity for further control on opioid prescriptions.
手术后开具的阿片类药物处方是阿片类药物滥用流行的主要原因。已经评估了几种旨在限制出院时开具阿片类药物处方的措施。我们对各种干预措施在减少泌尿外科手术后阿片类药物处方方面的有效性进行了全面的综述和荟萃分析。
系统检索了 MEDLINE®、Web of Science™ 和 Cochrane 数据库，以确定关于阿片类药物处方和泌尿外科手术的研究。符合纳入标准的 22 项研究中，有 19 项用于定量分析减少阿片类药物处方。其他结果包括阿片类药物的消耗量和镇痛满意度。
在 8318 名患者中，53%处于干预前组，47%处于干预后组。总体平均每位患者处方阿片类药物的减少量为-67.59（95%CI 54.23 至 80.94）吗啡毫克当量（MME）。与间接或系统干预相比，由提供者在其当地科室或医院内实施的直接干预更能有效减少处方阿片类药物，减少量为-76.68 MME（95%CI 60.04 至-93.31）与-46.72 MME（95%CI 24.20 至-69.23；p=0.04）。干预后阿片类药物的消耗量显著减少，平均减少量为-18.31 MME（95%CI 7.89 至 28.72）。干预前后两组患者的镇痛满意度无变化。
通过各种干预措施，可以成功减少阿片类药物处方，同时不影响疼痛控制。直接干预似乎比间接干预更能有效减少阿片类药物处方。尽管减少了，但仍有未使用的、过量的处方阿片类药物，这为进一步控制阿片类药物处方提供了机会。
