Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Department of Biostatistics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2024 Feb;170(2):405-413. doi: 10.1002/ohn.515. Epub 2023 Sep 13.
This study sought to analyze the efficacy and safety of postoperative prednisone to reduce reliance on opioids in adult benign oropharyngeal surgery.
Prospective cohort study.
Single tertiary-care facility.
Patients undergoing tonsillectomy (T), tonsillectomy and adenoidectomy (T&A), and/or modified uvulopalatopharyngoplasty (UPPP) from December 2020 to January 2023 received the standard of care postoperative management. A prednisone taper was dependent on surgeon preference. Cohorts were based on the prescription of postoperative steroids. Patients completed a survey to assess opioid usage, pain scores, and steroid compliance.
Seventy-two patients were included. The nonsteroid cohort (N = 29) received an average of 467 ± 94.1 morphine milligram equivalents (MME), and the steroid cohort (N = 43) received an average of 285 ± 128 MME (P < 0.001). The nonsteroid cohort consumed 1.62 times more opioids than the steroid cohort (P < 0.002). There were no significant differences in complication or refill rates between treatment groups. There were no significant differences in pain scores on the day of surgery or postoperative days 1, 5, or 10 (P = 0.34, P = 0.66, P = 0.62, and P = 0.22, respectively). Patients undergoing T&A (p = 0.019) or who had current psychiatric medication use (P < 0.006) consumed significantly more opioids. Patients who received a total opioid prescription of >300 MME (40 5-mL doses of 5 mg/5 mL liquid oxycodone) consumed 2.27 times more postoperative opioids than patients with opioid prescriptions ≤300 MME (P < 0.001).
Patients who did not receive steroids consumed 1.62 times more postoperative opioids compared to those who completed a steroid taper. Corticosteroid use was not associated with changes in pain scores, refill rates, or complication rates and may be considered in a multimodal approach to pain management in adults undergoing benign oropharyngeal surgery, although further study is warranted.
本研究旨在分析术后泼尼松治疗对减少成人良性口咽手术患者对阿片类药物依赖的疗效和安全性。
前瞻性队列研究。
单一三级保健机构。
2020 年 12 月至 2023 年 1 月期间，接受扁桃体切除术（T）、扁桃体切除术和腺样体切除术（T&A）和/或改良悬雍垂腭咽成形术（UPPP）的患者接受标准的术后管理。泼尼松的减量取决于外科医生的偏好。队列基于术后类固醇的处方。患者完成一项调查，以评估阿片类药物的使用、疼痛评分和类固醇的依从性。
共纳入 72 例患者。非类固醇组（N=29）平均接受 467±94.1 吗啡毫克当量（MME），类固醇组（N=43）平均接受 285±128 MME（P<0.001）。非类固醇组比类固醇组多使用 1.62 倍的阿片类药物（P<0.002）。两组之间的并发症或再填充率没有显著差异。手术当天或术后第 1、5、10 天的疼痛评分无显著差异（P=0.34、P=0.66、P=0.62 和 P=0.22）。行 T&A 手术的患者（p=0.019）或正在服用精神科药物的患者（P<0.006）使用的阿片类药物明显更多。接受的总阿片类药物处方量>300 MME（40 个 5-mL 剂量的 5mg/5mL 盐酸羟考酮）的患者比接受阿片类药物处方量≤300 MME 的患者多使用 2.27 倍的术后阿片类药物（P<0.001）。
与接受类固醇减量的患者相比，未接受类固醇治疗的患者术后阿片类药物的使用量多 1.62 倍。皮质类固醇的使用与疼痛评分、再填充率或并发症发生率的变化无关，在成人良性口咽手术的多模式疼痛管理中可能被考虑，尽管需要进一步的研究。
