Lee Kenny Kwon Ho, Siddiqui Saima, Heller Gillian, Clark Jonathan, Johns Amanda, Penm Jonathan
Department of Pharmacy, Chris O'Brien Lifehouse Hospital, Camperdown, NSW, Australia.
Head and Neck Research, Chris O'Brien Lifehouse Hospital, Camperdown, NSW, Australia.
Can J Anaesth. 2025 Jan;72(1):132-141. doi: 10.1007/s12630-024-02819-w. Epub 2024 Aug 12.
The management of pain following cancer-related surgeries involves the use of opioid analgesics. Nevertheless, there is little evidence characterizing the utility and prescription patterns of opioids after these procedures. Our primary aim was to identify patients from three types of cancer surgery who were overprescribed with opioids. The secondary aim was to determine the potential predictors of overprescribing in the same period.
We conducted the study at a single cancer referral hospital. Opioid-naïve patients with breast, gynecologic, or head and neck cancer were studied. Patients were considered opioid-naïve if they had a history of opioid use ≤ 30 mg oral morphine equivalent daily dose for less than seven days in the preceding three months before surgery. We recruited eligible participants by convenience sampling on the wards until at least 102 patients were included in the final analysis. After discharge, we followed up on the participants on day 7 via telephone using a structured proforma including questions to identify the last date and amount of opioid dose taken. The equivalent days of opioid use were calculated by their 24-hr use before discharge and the number of doses prescribed for discharge. Our primary outcome was the prevalence of overprescribing in the three surgical specialties defined as the number of patients taking less than 50% of discharge opioids within the first seven days after discharge. We examined the predictors on incidents of overprescribing using multivariable Poisson regression as the secondary outcome.
We recruited 119 patients, and 107 patients were included in the final analysis. There were 59/107 (55%) patients found to be overprescribed with opioids. At discharge, they exhibited lower mean numerical rating scale pain scores, lower mean pain severity scores, higher equivalent days of opioids prescribed, and not used opioids in the last 24 hr before discharge. The incidence of overprescribing was 2.4 times greater for patients prescribed with opioids without 24-hr opioid use (relative risk [RR], 2.38; 95% confidence interval [CI], 1.30 to 4.35; P = 0.005). Similarly, the incidence of overprescribing was 1.7 times greater for patients who had opioids 24 hr before discharge and were supplied with opioids for five equivalent days or more at the time of discharge (RR, 1.67; 95% CI, 1.09 to 2.56; P = 0.02).
Our study shows that the majority of recruited patients undergoing breast, gynecologic, or head and neck cancer surgery were overprescribed opioids. Individualized assessments on patients' 24-hr opioid requirements before discharge and supplying for less than five days are important considerations to reduce overprescribing in opioid-naïve patients after cancer surgery.
癌症相关手术后疼痛的管理涉及使用阿片类镇痛药。然而，几乎没有证据表明这些手术后阿片类药物的效用和处方模式。我们的主要目的是识别三类癌症手术中阿片类药物处方过量的患者。次要目的是确定同期处方过量的潜在预测因素。
我们在一家癌症转诊医院进行了这项研究。研究对象为未使用过阿片类药物的乳腺癌、妇科癌或头颈癌患者。如果患者在手术前三个月内，口服吗啡等效剂量≤30mg/天且使用时间少于七天，则被视为未使用过阿片类药物。我们通过便利抽样在病房招募符合条件的参与者，直至至少102名患者纳入最终分析。出院后，我们在第7天通过电话对参与者进行随访，使用结构化表格，包括询问确定最后一次服用阿片类药物的日期和剂量。阿片类药物使用的等效天数通过出院前24小时的使用量和出院时开具的剂量数来计算。我们的主要结局是三个外科专科中处方过量的患病率，定义为出院后前七天内服用少于50%出院时开具的阿片类药物的患者数量。我们使用多变量泊松回归作为次要结局，研究处方过量事件的预测因素。
我们招募了119名患者，107名患者纳入最终分析。发现107名患者中有59名（55%）阿片类药物处方过量。出院时，他们的平均数字评定量表疼痛评分较低，平均疼痛严重程度评分较低，开具的阿片类药物等效天数较高，且在出院前最后24小时未使用阿片类药物。未在24小时内使用阿片类药物的患者处方过量的发生率高2.4倍（相对风险[RR]，2.38；95%置信区间[CI]，1.30至4.35；P = 0.005）。同样，出院前24小时使用过阿片类药物且出院时开具了相当于五天或更多天用量的阿片类药物的患者，处方过量的发生率高1.7倍（RR，1.67；95%CI，1.09至2.56；P = 0.02）。
我们的研究表明，大多数招募的接受乳腺癌、妇科癌或头颈癌手术的患者阿片类药物处方过量。在出院前对患者24小时阿片类药物需求进行个体化评估，并开具少于五天的用量，是减少癌症手术后未使用过阿片类药物患者处方过量的重要考虑因素。
