From the Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada.
From the Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada.
J Minim Invasive Gynecol. 2022 Jul;29(7):823-831.e7. doi: 10.1016/j.jmig.2022.04.017. Epub 2022 May 2.
To perform a systematic review on consumption, leftover, and disposal of prescribed opioids after surgery in obstetrics and gynecology (The International Prospective Register of Systematic Reviews ID 249856).
Electronic database searches on PubMed, Embase, Cochrane Library, and MEDLINE and other search methods including all studies published between the years 2000 and 2021 were used.
We included all randomized trials, cohorts, case-control studies, and clinical trials. The search was limited to studies related to obstetrics and gynecology. Studies that pertained to opioid consumption, leftover, and disposal patterns were selected. We excluded review articles, meeting abstracts, case series and case reports, and abstracts without access to full texts. The search was limited to trials in humans and published in English language. Study population included women who were prescribed opioids after obstetric and/or gynecologic procedures. Information on opioid consumption, leftover, and disposal patterns were extracted and compared among different procedures. Potential risk of bias was evaluated using the Newcastle-Ottawa Scale for cohort studies and the National Heart, Lung, and Blood Institute Study Quality Assessment Tool of Controlled Interventional Studies for clinical trial.
TABULATION, INTEGRATION, AND RESULTS: Of 2343 articles, 10 were used in the analysis: 9 cohorts and 1 randomized clinical trial. We found that among patients who underwent obstetric and gynecologic procedures, a considerable number of opioids are unused. The total number of consumed opioids after discharge in patients who underwent cesarean delivery was 21.8 oral morphine equivalent (OME); vaginal hysterectomy, 55.7 OME; abdominal hysterectomy, 105.8 OME; and laparoscopic hysterectomy, 89.0 OME. The number of opioids leftover in the vaginal, abdominal, and laparoscopic hysterectomy groups was 67.6 OME, 115.5 OME, and 95.3 OME, respectively. On average, 77.5% of leftover opioids were not disposed/kept, whereas only 20% discarded their medication through a disposal program. Five studies were deemed to have fair quality, and the rest were rated as good quality.
Compared with those after cesarean delivery, patients undergoing gynecologic procedures consumed a large number of opioids, especially after abdominal hysterectomies. Abdominal hysterectomy was also associated with a high number of opioids leftover. Most patients did not use the entire prescribed opioids and were either keeping their unused opioids or unsure about what to do with them. We recommend perioperative opioid-specific counseling and education on opioid consumption, potential hazards of unused medication, and proper disposal for patients. Strategies to reduce opioids prescription by physicians should be considered.
对妇产科手术后处方阿片类药物的使用、剩余和处理进行系统评价（国际前瞻性登记系统评价编号 249856）。
使用电子数据库搜索 PubMed、Embase、Cochrane 图书馆和 MEDLINE 以及其他搜索方法，检索时间为 2000 年至 2021 年发表的所有研究。
我们纳入了所有随机试验、队列研究、病例对照研究和临床试验。研究仅限于与妇产科相关的研究。选择了与阿片类药物使用、剩余和处理模式相关的研究。我们排除了综述文章、会议摘要、病例系列和病例报告以及无法获取全文的摘要。研究仅限于人类，并以英文发表。研究人群包括接受产科和/或妇科手术后开阿片类药物的女性。提取并比较了不同手术中阿片类药物使用、剩余和处理模式的信息。使用纽卡斯尔-渥太华量表对队列研究和国家心肺血液研究所对照干预研究质量评估工具对临床试验进行潜在偏倚风险评估。
列表、整合和结果：在 2343 篇文章中，有 10 篇被用于分析：9 篇队列研究和 1 篇随机临床试验。我们发现，在接受妇产科手术的患者中，相当一部分阿片类药物未使用。行剖宫产术的患者出院后消耗的阿片类药物总量为 21.8 个口服吗啡当量（OME）；阴道子宫切除术为 55.7 OME；腹式子宫切除术为 105.8 OME；腹腔镜子宫切除术为 89.0 OME。阴道、腹部和腹腔镜子宫切除术组剩余的阿片类药物数量分别为 67.6 OME、115.5 OME 和 95.3 OME。平均而言，77.5%的剩余阿片类药物未被使用/保留，而只有 20%的患者通过处理计划丢弃了他们的药物。五项研究被认为质量中等，其余研究被评为高质量。
与剖宫产术后相比，行妇科手术的患者消耗大量阿片类药物，尤其是腹式子宫切除术。腹式子宫切除术也与大量剩余阿片类药物有关。大多数患者没有使用全部规定的阿片类药物，要么保留未使用的阿片类药物，要么不确定如何处理。我们建议对患者进行围手术期阿片类药物特定咨询和教育，包括阿片类药物使用、未使用药物的潜在危害以及正确处理。应考虑减少医生开具阿片类药物处方的策略。
