Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
JSLS. 2022 Jul-Sep;26(3). doi: 10.4293/JSLS.2022.00041.
To evaluate postoperative opioid use after benign minimally-invasive gynecologic surgery and assess the impact of a patient educational intervention regarding proper opioid use/disposal.
Educational pamphlets were provided preoperatively. Patients underwent hysterectomy, myomectomy, or other laparoscopic procedures. Opioid prescriptions were standardized with 25 tablets oxycodone 5mg for hysterectomy/myomectomy, 10 tablets oxycodone 5mg for LSC (oral morphine equivalents were maintained for alternatives). Pill diaries were reviewed and patient surveys completed during postoperative visits.
Of 106 consented patients, 65 (61%) completed their pill diaries. Median opioid use was 35 OME for hysterectomy (∼5 oxycodone tablets; IQR 11.25-102.5), 30 OME for myomectomy (∼4 tablets; IQR 15-75), and 18.75 OME for laparoscopy (∼3 tablets; IQR 7.5-48.75). Median last post-operative day (d) of use was 3d for hysterectomy (IQR 2, 8), 4d for myomectomy (IQR 1, 7), and 2d for laparoscopy (IQR 0.5-3.5). One patient (myomectomy) required a refill of 5mg oxycodone. No difference was found between total opioid use and presence of pelvic pain, chronic pain disorders, or psychiatric co-morbidities. Overall satisfaction with pain control (>4 on a 5-point Likert scale) was 91% for hysterectomy, 100% for myomectomy, 83% for laparoscopy. Of the 33 patients who read the pamphlet, 32(97%) felt it increased their awareness.
Most patients required <10 oxycodone 5mg tablets, regardless of procedure with excellent patient satisfaction. A patient education pamphlet is a simple method to increase knowledge regarding the opioid epidemic and facilitate proper medication disposal.
评估良性微创妇科手术后的阿片类药物使用情况，并评估针对阿片类药物正确使用/处置的患者教育干预的影响。
术前提供教育小册子。患者接受了子宫切除术、子宫肌瘤切除术或其他腹腔镜手术。阿片类药物处方标准化，子宫切除术/子宫肌瘤切除术使用 25 片 5mg 羟考酮，LSC 使用 10 片 5mg 羟考酮（替代药物保持口服吗啡当量）。审查药丸日记并在术后就诊期间完成患者调查。
在 106 名同意参与的患者中，有 65 名（61%）完成了药丸日记。子宫切除术的中位数阿片类药物用量为 35 OME（约 5 片羟考酮；IQR 11.25-102.5），子宫肌瘤切除术为 30 OME（约 4 片；IQR 15-75），腹腔镜检查为 18.75 OME（约 3 片；IQR 7.5-48.75）。子宫切除术的中位数最后一次术后使用天数（d）为 3d（IQR 2,8），子宫肌瘤切除术为 4d（IQR 1,7），腹腔镜检查为 2d（IQR 0.5-3.5）。一名患者（子宫肌瘤切除术）需要补充 5mg 羟考酮。阿片类药物总用量与盆腔疼痛、慢性疼痛障碍或精神科合并症的存在之间没有差异。子宫切除术的疼痛控制总体满意度（5 分李克特量表上>4 分）为 91%，子宫肌瘤切除术为 100%，腹腔镜检查为 83%。在阅读小册子的 33 名患者中，有 32 名（97%）表示这增加了他们的认识。
大多数患者无论手术类型如何，都需要<10 片 5mg 羟考酮，且患者满意度均很高。患者教育小册子是一种提高对阿片类药物流行的认识并促进正确药物处置的简单方法。
