Madsen Annetta M, Martin Jessica M, Linder Brian J, Gebhart John B
Department of Obstetrics & Gynecology, Division of Urogynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Obstetrics & Gynecology, Division of Urogynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Best Pract Res Clin Obstet Gynaecol. 2022 Dec;85(Pt B):68-80. doi: 10.1016/j.bpobgyn.2022.05.006. Epub 2022 Jun 6.
Given the high volume of hysterectomies performed, the contribution of gynecologists to the opioid crisis is potentially significant. Following a hysterectomy, most patients are over-prescribed opioids, are vulnerable to developing new persistent opioid use, and can be the source of misuse, diversion, or accidental exposure. People who misuse opioids are at risk of an overdose related death, which is now one of the leading causes of death in the United States and is rising in other countries. It is the physician's responsibility to reduce opioid use by making impactful practice changes, such as 1) using pre-emptive opioid sparing strategies, 2) optimizing multimodal nonopioid pain management, 3) restricting postoperative opioid prescribing, and 4) educating patients on proper disposal of unused opioids. These changes can be implemented with an enhanced recovery after surgery protocol, shared decision-making, and patient education strategies related to opioids.
鉴于子宫切除术的实施数量众多，妇科医生对阿片类药物危机的影响可能很大。子宫切除术后，大多数患者的阿片类药物处方过量，容易出现新的持续性阿片类药物使用情况，并且可能成为药物滥用、转移或意外接触的源头。滥用阿片类药物的人有因过量用药而死亡的风险，这现已成为美国主要死因之一，且在其他国家也呈上升趋势。医生有责任通过做出有效的实践改变来减少阿片类药物的使用，例如：1）采用预防性阿片类药物节省策略；2）优化多模式非阿片类疼痛管理；3）限制术后阿片类药物处方；4）对患者进行未使用阿片类药物妥善处理的教育。这些改变可以通过术后强化康复方案、共同决策以及与阿片类药物相关的患者教育策略来实施。
