耳鼻喉科术后阿片类药物与非阿片类药物疼痛管理。
Opioid versus non-opioid postoperative pain management in otolaryngology.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Penn State Health, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
出版信息
BMC Anesthesiol. 2023 Aug 25;23(1):291. doi: 10.1186/s12871-023-02213-x.
BACKGROUND
The opioid epidemic in the United States has had devastating consequences, with many opioid-related deaths and a significant economic toll. Opioids have a significant role in postoperative pain management. Here we aim to analyze differences in postoperative opioid and non-opioid pain medications regimens following common otolaryngological surgeries between two large tertiary care medical centers: the Milton S. Hershey Medical Center, USA (HMC) and The Chaim Sheba Medical center, Israel (SMC).
METHODS
A retrospective chart review of patients undergoing common otolaryngological procedures during the years 2017-2019 was conducted at two tertiary care centers, one in the U.S. and the other in Israel. Types and doses of postoperative pain medications ordered and administered during admission were analyzed. Average doses ordered and administered in 24 h were calculated. Opioid medications were converted to a standardized unit of morphine milliequivalents (MME). Chi-square test and Wilcoxon rank-sum test were used to compare the groups.
RESULTS
The study included 204 patients (103 U.S., 101 Israel). Patient demographics were similar except for a longer length of stay in Israel (p < 0.01). In the U.S., 95% of patients were ordered opioids compared to 70% in Israel (P < 0.01). In the U.S., 68.9% of patients ordered opioids received the medications compared to 29.7% in Israel. The median opioid dose ordered in the U.S. was 45MME/24 h compared to 30MME/24 h in Israel (P < 0.01), while median dose received in the U.S. was 15MME/24 h compared to 3.8MME/24 h in Israel (P < 0.01). Opioid prescriptions at discharge were given to 92% of patients in the U.S. compared to 4% of patients in Israel (p < 0.01). A significantly higher number of patients in the U.S. were prescribed acetaminophen and ibuprofen (p < 0.0001). Dipyrone was prescribed to 78% of patients in Israel.
CONCLUSIONS
HMC demonstrated a significantly more permissive approach to both prescribing and consuming opioid medications for postoperative pain management than SMC for similar, common otolaryngological surgeries. Non-opioid alternatives and examining the cultural and medical practice-based differences contributing to the opioid epidemic should be discussed and reevaluated.
背景
美国的阿片类药物泛滥造成了毁灭性的后果，导致许多阿片类药物相关死亡和巨大的经济损失。阿片类药物在术后疼痛管理中起着重要作用。在这里，我们旨在分析美国两家大型三级保健医疗中心（米尔顿·S·赫希医疗中心，美国[HMC]和以色列谢巴医疗中心[SMC]）在接受常见耳鼻喉科手术后，患者术后阿片类药物和非阿片类药物疼痛管理方案的差异。
方法
对 2017 年至 2019 年间在两家三级保健医疗中心接受常见耳鼻喉科手术的患者进行了回顾性图表审查，一家在美国，另一家在以色列。分析了住院期间开的和用的术后疼痛管理药物的类型和剂量。计算了 24 小时内开的和用的平均剂量。将阿片类药物换算为标准化吗啡毫当量单位（MME）。采用卡方检验和 Wilcoxon 秩和检验对两组进行比较。
结果
研究纳入了 204 名患者（美国 103 名，以色列 101 名）。患者的人口统计学特征相似，但以色列的住院时间较长（p<0.01）。在美国，95%的患者开了阿片类药物，而以色列为 70%（P<0.01）。在美国，68.9%的开了阿片类药物的患者接受了治疗，而以色列为 29.7%。美国开的阿片类药物的中位数剂量为 45MME/24 小时，而以色列为 30MME/24 小时（P<0.01），而美国用的中位数剂量为 15MME/24 小时，而以色列为 3.8MME/24 小时（P<0.01）。在美国，92%的患者出院时开了阿片类药物处方，而以色列为 4%（p<0.01）。美国患者开的对乙酰氨基酚和布洛芬的比例明显高于以色列（p<0.0001）。以色列 78%的患者开了双氯芬酸。
结论
与接受类似常见耳鼻喉科手术的 SMC 相比，HMC 在开阿片类药物处方和使用阿片类药物治疗术后疼痛管理方面的态度要宽松得多。应讨论并重新评估非阿片类药物替代品，并研究造成阿片类药物泛滥的文化和医疗实践差异的原因。
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