妇科手术后急性疼痛的处方阿片类药物使用及持续阿片类药物使用：一项系统评价
Prescription Opioid Use for Acute Pain and Persistent Opioid Use After Gynecologic Surgery: A Systematic Review.
作者信息
Matteson Kristen A, Schimpf Megan O, Jeppson Peter C, Thompson Jennifer C, Gala Rajiv B, Balgobin Sunil, Gupta Ankita, Hobson Deslyn, Olivera Cedric, Singh Ruchira, White Amanda B, Balk Ethan M, Meriwether Kate V
机构信息
Women and Infants Hospital, Warren Alpert Medical School of Brown University, and the Center for Evidence Based Medicine, Brown University School of Public Health, Providence, Rhode Island; the University of Michigan, Ann Arbor, Michigan; the University of New Mexico, Albuquerque, New Mexico; Northwest Kaiser Permanente, Portland, Oregon; the University of Queensland / Ochsner Clinical School, New Orleans, Louisiana; the University of Texas Southwestern Medical Center, Dallas, Texas; the University of Louisville Health, Louisville, Kentucky; the Wayne State University School of Medicine, Detroit, Michigan; the Icahn School of Medicine at Mount Sinai, New York, New York; the University of Florida, Jacksonville, Florida; and Dell Medical School, University of Texas at Austin, Austin, Texas.
出版信息
Obstet Gynecol. 2023 Apr 1;141(4):681-696. doi: 10.1097/AOG.0000000000005104. Epub 2023 Mar 9.
OBJECTIVE
To assess the amount of opioid medication used by patients and the prevalence of persistent opioid use after discharge for gynecologic surgery for benign indications.
DATA SOURCES
We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from inception to October 2020.
METHODS OF STUDY SELECTION
Studies with data on gynecologic surgical procedures for benign indications and the amount of outpatient opioids consumed, or the incidence of either persistent opioid use or opioid-use disorder postsurgery were included. Two reviewers independently screened citations and extracted data from eligible studies.
TABULATION, INTEGRATION, AND RESULTS: Thirty-six studies (37 articles) met inclusion criteria. Data were extracted from 35 studies; 23 studies included data on opioids consumed after hospital discharge, and 12 studies included data on persistent opioid use after gynecologic surgery. Average morphine milligram equivalents (MME) used in the 14 days after discharge were 54.0 (95% CI 39.9-68.0, seven tablets of 5-mg oxycodone) across all gynecologic surgery types, 35.0 (95% CI 0-75.12, 4.5 tablets of 5-mg oxycodone) after a vaginal hysterectomy, 59.5 (95% CI 44.4-74.6, eight tablets of 5-mg oxycodone) after laparoscopic hysterectomy, and 108.1 (95% CI 80.5-135.8, 14.5 tablets of 5-mg oxycodone) after abdominal hysterectomy. Patients used 22.4 MME (95% CI 12.4-32.3, three tablets of 5-mg oxycodone) within 24 hours of discharge after laparoscopic procedures without hysterectomy and 79.8 MME (95% CI 37.1-122.6, 10.5 tablets of 5-mg oxycodone) from discharge to 7 or 14 days postdischarge after surgery for prolapse. Persistent opioid use occurred in about 4.4% of patients after gynecologic surgery, but this outcome had high heterogeneity due to variation in populations and definitions of the outcome.
CONCLUSION
On average, patients use the equivalent of 15 or fewer 5-mg oxycodone tablets (or equivalent) in the 2 weeks after discharge after major gynecologic surgery for benign indications. Persistent opioid use occurred in 4.4% of patients who underwent gynecologic surgery for benign indications. Our findings could help surgeons minimize overprescribing and reduce medication diversion or misuse.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42020146120.
目的
评估因良性指征接受妇科手术的患者使用阿片类药物的剂量以及出院后持续使用阿片类药物的情况。
数据来源
我们系统检索了自数据库创建至2020年10月的MEDLINE、EMBASE和ClinicalTrials.gov。
研究选择方法
纳入有关因良性指征进行的妇科手术程序以及门诊阿片类药物消耗量数据，或术后持续使用阿片类药物或阿片类药物使用障碍发生率的研究。两名评审员独立筛选文献并从符合条件的研究中提取数据。
制表、整合与结果：36项研究（37篇文章）符合纳入标准。从35项研究中提取了数据；23项研究包括出院后阿片类药物使用的数据，12项研究包括妇科手术后持续使用阿片类药物的数据。所有类型妇科手术后出院后14天内平均吗啡毫克当量（MME）为54.0（95%CI 39.9 - 68.0，相当于7片5毫克羟考酮），阴道子宫切除术后为35.0（95%CI 0 - 75.12，相当于4.5片5毫克羟考酮）,腹腔镜子宫切除术后为59.5（95%CI 44.4 - 74.6，相当于8片5毫克羟考酮），腹式子宫切除术后为108.1（95%CI 80.5 - 135.8，相当于14.5片5毫克羟考酮）。未行子宫切除的腹腔镜手术后出院后24小时内患者使用22.4 MME（95%CI 12.4 - 32.3，相当于3片5毫克羟考酮），脱垂手术后出院至出院后7或14天使用79.8 MME（95%CI 37.1 - 122.6，相当于10.5片5毫克羟考酮）。妇科手术后约4.4%的患者持续使用阿片类药物，但由于人群和结局定义的差异，该结果具有高度异质性。
结论
平均而言，因良性指征接受大型妇科手术后出院的患者在2周内使用相当于15片或更少的5毫克羟考酮片（或等效药物）。因良性指征接受妇科手术的患者中有4.4%持续使用阿片类药物。我们的研究结果有助于外科医生尽量减少处方过量，并减少药物转移或滥用。
系统评价注册
PROSPERO，CRD42020146120
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