Hamour Amr F, Manojlovic-Kolarski Mirko, Eskander Antoine, Biskup Mathew, Taylor S Mark, Laliberte Frederick, Vescan Allan, Witterick Ian J, Freeman Jeremy, Monteiro Eric
Department of Otolaryngology - Head & Neck Surgery University of Toronto Toronto Ontario Canada.
Department of Otolaryngology - Head & Neck Surgery Michael Garron Hospital Toronto Ontario Canada.
Laryngoscope Investig Otolaryngol. 2023 Apr 24;8(3):786-791. doi: 10.1002/lio2.1065. eCollection 2023 Jun.
Opioid abuse is widespread in North America and the over-prescription of opioids are a contributing factor. The goal of this prospective study was to quantify over-prescription rates, evaluate postoperative experiences of pain, and understand the impact of peri-operative factors such as adequate pain counseling and use of non-opioid analgesia.
Consecutive recruitment of patients undergoing head and neck endocrine surgery was undertaken from January 1st 2020 to December 31st 2021 at four Canadian hospitals in Ontario and Nova Scotia. Postoperative tracking of pain levels and analgesic requirements were employed. Chart review and preoperative and postoperative surveys provided information on counseling, use of local anesthesia, and disposal plans.
A total of 125 adult patients were included in the final analysis. Total thyroidectomy was the most common procedure (40.8%). Median use of opioid tablets was 2 (IQR 0-4), with 79.5% of prescribed tablets unused. Patients who reported inadequate counseling ( = 35, 28.0%) were more likely to use opioids (57.2% vs. 37.8%, < .05) and less likely to use non-opioid analgesia in the early postoperative course (42.9% vs. 63.3%, < .05). Patients who received local anesthesia peri-operatively (46.4%, = 58) reported less severe pain on average [2.86 (2.13) vs. 4.86 (2.19), < .05] and used less analgesia on postoperative day one [0 MME (IQR 0-4) vs. 4 MME (IQR 0-8), < .05].
Over-prescription of opioid analgesia following head and neck endocrine surgery is common. Patient counseling, use of non-opioid analgesia, and peri-operative local anesthesia were important factors in narcotic use reduction.
Level 3.
阿片类药物滥用在北美地区广泛存在，阿片类药物的过度处方是一个促成因素。这项前瞻性研究的目的是量化过度处方率，评估术后疼痛体验，并了解围手术期因素（如充分的疼痛咨询和非阿片类镇痛药物的使用）的影响。
2020年1月1日至2021年12月31日期间，在安大略省和新斯科舍省的四家加拿大医院连续招募接受头颈内分泌手术的患者。对术后疼痛水平和镇痛需求进行跟踪。通过病历审查以及术前和术后调查获取有关咨询、局部麻醉使用和处置计划的信息。
共有125名成年患者纳入最终分析。全甲状腺切除术是最常见的手术（40.8%）。阿片类药片的中位使用量为2片（四分位间距0 - 4），79.5%的处方药片未使用。报告咨询不足的患者（n = 35，28.）更有可能使用阿片类药物（57.2%对37.8%，P < 0.05），且在术后早期不太可能使用非阿片类镇痛药物（42.9%对63.3%），P < 0.05）。围手术期接受局部麻醉的患者（46.4%，n = 58）平均报告的疼痛较轻[2.86（2.13）对4.86（2.19），P < 0.05]，术后第一天使用的镇痛药物较少[0 MME（四分位间距0 - 4）对4 MME（四分位间距0 - 8）] P < 0.05）。
头颈内分泌手术后阿片类镇痛药物的过度处方很常见。患者咨询、非阿片类镇痛药物使用和围手术期局部麻醉是减少麻醉药物使用的重要因素。
3级
