门诊小儿普通外科和泌尿科手术后的疼痛管理中的患者报告结局。
Patient-Reported Outcomes in Pain Management After Ambulatory Pediatric General and Urologic Surgery.
机构信息
Department of Surgery, Nemours Children's Health, Wilmington, DE, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
出版信息
J Pediatr Surg. 2023 Sep;58(9):1816-1823. doi: 10.1016/j.jpedsurg.2023.01.049. Epub 2023 Feb 10.
BACKGROUND
Many studies evaluating opioid stewardship interventions' effects on postoperative pain rely on emergency department (ED) visits or readmissions, but patient-reported pain scores represent a more complete picture of the postoperative experience. This study compares patient-reported pain scores after ambulatory pediatric and urologic procedures and the effect of an opioid stewardship intervention that nearly eliminated the use of outpatient narcotics.
METHODS
This is a retrospective comparative study including 3173 pediatric patients who underwent ambulatory procedures from 2015 to 2019, during which there was an intervention to reduce narcotic prescriptions. Postoperative day one phone calls assessed pain levels using a four-point scale (no pain, mild pain, moderate pain controlled with medication, or severe pain uncontrolled with medication). We quantified the proportion of patients prescribed opioids pre-versus post-intervention and compared pain scores for patients receiving opioid versus non-opioid regimens.
RESULTS
Opioid prescription rates demonstrated a 6.5-fold reduction after opioid stewardship efforts. The majority of patients (2838) received non-opioids, with only 335 patients receiving opioids. Opioid patients reported moderate/severe pain slightly more than non-opioid patients (14.1% vs. 10.4%, p = 0.04). On by-procedure analyses, there were no subgroups in which non-opioid patients reported significantly higher pain scores.
CONCLUSIONS
Non-opioid postoperative pain regimens appear to be effective, with only 10.4% of patients reporting moderate/severe pain after ambulatory procedures. Future studies assessing patient-reported outcomes are necessary to optimize pain control for all patients and to determine whether there is ever an indication for opioid prescription after ambulatory general pediatric or urologic surgery.
TYPE OF STUDY
Retrospective comparative study.
LEVEL OF EVIDENCE
Level III.
背景
许多评估阿片类药物管理干预措施对术后疼痛影响的研究都依赖于急诊（ED）就诊或再入院，但患者报告的疼痛评分更能全面反映术后体验。本研究比较了门诊小儿和泌尿科手术后患者报告的疼痛评分，以及一项几乎消除门诊麻醉性镇痛药使用的阿片类药物管理干预措施的效果。
方法
这是一项回顾性比较研究，纳入了 2015 年至 2019 年期间接受门诊手术的 3173 名小儿患者，在此期间实施了一项减少麻醉性镇痛药处方的干预措施。术后第 1 天通过电话评估疼痛程度，使用 4 分制（无痛、轻度疼痛、中度疼痛用药物控制、重度疼痛未用药物控制）。我们量化了干预前后开具麻醉性镇痛药处方的患者比例，并比较了接受阿片类药物与非阿片类药物治疗方案患者的疼痛评分。
结果
阿片类药物管理努力后，阿片类药物处方率降低了 6.5 倍。大多数患者（2838 名）接受了非阿片类药物治疗，只有 335 名患者接受了阿片类药物治疗。阿片类药物治疗患者报告的中度/重度疼痛略高于非阿片类药物治疗患者（14.1%比 10.4%，p=0.04）。按手术类型分析，非阿片类药物治疗患者报告的疼痛评分显著更高的亚组均不存在。
结论
非阿片类药物术后疼痛治疗方案似乎有效，仅 10.4%的门诊手术患者报告中度/重度疼痛。未来评估患者报告结局的研究对于优化所有患者的疼痛控制以及确定门诊普通小儿或泌尿科手术后是否存在开具阿片类药物处方的指征是必要的。
研究类型
回顾性比较研究。
证据等级
III 级。
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