Long-Lijoi Katherine L, Mukherjee Hrijeeta, Pinell Ximena A, Grimmer Karl, Davison Steven P
From the Drexel University College of Medicine, Reading, Pa.
Davinci Plastic Surgery, Washington, D.C.
Plast Reconstr Surg Glob Open. 2023 Aug 9;11(8):e5181. doi: 10.1097/GOX.0000000000005181. eCollection 2023 Aug.
This trial aimed to compare the efficacy of a multimodal analgesic regimen with gabapentin to a multimodal nonsteroidal anti-inflammatory drug (NSAID) regimen following cosmetic surgery. This was a prospective randomized study of 106 patients undergoing elective outpatient cosmetic surgery.
Patients were randomly assigned to a multimodal regimen of postoperative acetaminophen, gabapentin, and oxycodone with an acetaminophen and gabapentin preload or postoperative ibuprofen and oxycodone-acetaminophen protocol without a preload. Data on compliance, number of narcotic pills consumed, duration of analgesic use, pain levels, patient satisfaction, time from incision close to postanesthesia care unit (PACU) admission, and incidence of bleeding-related complications were collected and analyzed.
Patients from both regimens reported equivalent postoperative pain control with the exception of pain in PACU. NSAID patients exhibited a 9.3% higher rate of compliance ( = 0.01), a 6.0% higher rate of satisfaction with pain control ( = 0.04), a 25.2% shorter interval between closure and PACU (=0.01), and an 8.2% lower rate of bleeding-related complications, all of which were statistically significant ( < 0.05).
Both regimens are viable tools in combating opioid overprescription as they both effectively reduce postoperative pain. However, the NSAID protocol resulted in greater satisfaction related to pain management and was more cost-effective by reducing emergence time from anesthesia. As there were no hematomas associated with the use of NSAIDs and a significantly higher rate of compliance, the use of NSAIDs in enhanced recovery after surgery protocols is supported.
本试验旨在比较多模式镇痛方案联合加巴喷丁与多模式非甾体抗炎药（NSAID）方案在整形手术后的疗效。这是一项对106例行择期门诊整形手术患者的前瞻性随机研究。
患者被随机分配至术后对乙酰氨基酚、加巴喷丁和羟考酮的多模式方案，并预先服用对乙酰氨基酚和加巴喷丁，或术后布洛芬和对乙酰氨基酚-羟考酮方案且无预负荷。收集并分析关于依从性、服用麻醉药片数量、镇痛使用时长、疼痛程度、患者满意度、从切口闭合到进入麻醉后护理单元（PACU）的时间以及出血相关并发症发生率的数据。
除在PACU的疼痛外，两种方案的患者术后疼痛控制情况相当。NSAID组患者的依从率高9.3%（P = 0.01），对疼痛控制的满意度高6.0%（P = 0.04），闭合与进入PACU之间的间隔时间短25.2%（P = 0.01），出血相关并发症发生率低8.2%，所有这些均具有统计学意义（P < 0.05）。
两种方案都是对抗阿片类药物过度处方的可行工具，因为它们都能有效减轻术后疼痛。然而，NSAID方案在疼痛管理方面带来更高的满意度，并且通过减少麻醉苏醒时间更具成本效益。由于使用NSAIDs未出现血肿且依从率显著更高，因此支持在术后加速康复方案中使用NSAIDs。
