Castellanos Carlos X, Paoletti Marcus, Ulloa Ruben, Kim Celeste, Fong Michelle, Xepoleas Meredith, Sinha Uttam, Kokot Niels, Swanson Mark S
Caruso Department of Otolaryngology-Head & Neck Surgery Keck Medicine of University of Southern California Los Angeles California USA.
OTO Open. 2023 Mar 14;7(1):e17. doi: 10.1002/oto2.17. eCollection 2023 Jan-Mar.
To compare postoperative pain scores and opioid consumption in patients after transoral robotic surgery (TORS).
Single institution retrospective cohort study.
TORS was performed at a single academic tertiary care center.
This study compared traditional opioid-based and opioid-sparing multimodal analgesia (MMA) regimens in patients with oropharyngeal and supraglottic malignancy after TORS. Data were obtained from the electronic health records from August 2016 to December 2021. The average postoperative pain scores and total opioid consumption in morphine milligram equivalents were calculated for postoperative days (PODs) 0 to 3. The secondary objectives were to quantify and characterize opioid prescriptions upon hospital discharge.
A total of 114 patients were identified for this study, 58 patients in the non-MMA cohort and 56 in the MMA cohort. Postoperative pain levels in the MMA cohort were statistically lower on POD 0 ( = 0.001), POD 1 ( = 0.001), and POD 3 ( = 0.004). Postoperative opioid consumption decreased significantly in the MMA cohort from 37.7 to 10.8 mg on POD 0 ( = 0.002), 65.9 to 19.9 mg on POD 1 ( < 0.001), 36.0 to 19.3 mg on POD 2 ( = 0.02), and 45.4 to 13.8 mg on POD 3 ( = 0.02). The number of patients discharged from the hospital with a prescription for narcotics was significantly lower in the MMA cohort (71.4%) compared with the non-MMA cohort (98.3%) ( < 0.001).
Implementation of our MMA pain protocol reduced pain levels and narcotic consumption in the immediate postoperative period.
比较经口机器人手术（TORS）患者术后疼痛评分及阿片类药物用量。
单机构回顾性队列研究。
在一家学术性三级医疗中心进行TORS手术。
本研究比较了TORS术后口咽及声门上恶性肿瘤患者基于传统阿片类药物和阿片类药物节省多模式镇痛（MMA）方案。数据来自2016年8月至2021年12月的电子健康记录。计算术后0至3天的平均术后疼痛评分及以吗啡毫克当量计的总阿片类药物用量。次要目标是量化并描述出院时的阿片类药物处方情况。
本研究共纳入114例患者，非MMA队列58例，MMA队列56例。MMA队列术后第0天（P = 0.001）、第1天（P = 0.001）和第3天（P = 0.004）的疼痛水平在统计学上较低。MMA队列术后阿片类药物用量在术后第0天从37.7毫克显著降至10.8毫克（P = 0.002），第1天从65.9毫克降至19.9毫克（P < 0.001），第2天从36.0毫克降至19.3毫克（P = 0.02），第3天从45.4毫克降至13.8毫克（P = 0.02）。与非MMA队列（98.3%）相比，MMA队列出院时开具麻醉药品处方的患者数量显著更低（71.4%）（P < 0.001）。
实施我们的MMA疼痛方案可降低术后即刻的疼痛水平及麻醉药品用量。
