Sharpe Megan G, Shah Varun S, Huerta Mina, Stitzel Henry, Desai Ansh, Labak Collin M, Andrews Kathryn, Stout Amber, Staudt Michael D
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Neurosurg Rev. 2024 Dec 3;47(1):884. doi: 10.1007/s10143-024-03131-3.
Over the past two decades, the United States has experienced a rise of opioid misuse, with a significant increase in drug overdose deaths- many of these deaths have been attributed to prescription opiate misuse. Given this epidemic, numerous specialties have created enhanced recovery after surgery protocols to decrease opiate usage post-operatively and some specialties have even created guidelines advising how many morphine milligram equivalents per day are recommended at discharge. The neurosurgical literature is lacking on best practices for discharge opiate prescribing. The goal of this review is to assess opiate prescribing practices at discharge for both cranial and spine neurosurgical patients, and to determine if neurosurgeons are over-prescribing opiates to their patients. A systematic literature review was performed according to PRISMA guidelines. After searching PubMed, Cochrane, and Embase, a total of 288 abstracts were identified, 71 studies underwent full text review and 23 were included in this study. Studies that quantified opiate usage (number of pills prescribed, morphine equivalents, prescription refills) were included. The range of opiate prescribing varied and there was a tendency to both over-prescribe and under-prescribe; therefore, no conclusions could be made. This review underscores the need to take individual patient pain needs into account and shows the need for higher quality literature that can help formulate guideline creation.
在过去二十年中，美国阿片类药物滥用情况呈上升趋势，药物过量致死人数显著增加——其中许多死亡归因于处方阿片类药物的滥用。鉴于这种流行情况，众多专业领域制定了术后强化康复方案以减少术后阿片类药物的使用，一些专业领域甚至制定了指南，建议出院时每天推荐使用多少毫克吗啡当量。神经外科文献缺乏关于出院时阿片类药物处方的最佳实践。本综述的目的是评估颅脑和脊柱神经外科患者出院时的阿片类药物处方实践，并确定神经外科医生是否给患者过度开具阿片类药物。根据PRISMA指南进行了系统的文献综述。在检索了PubMed、Cochrane和Embase之后，共识别出288篇摘要，71项研究进行了全文审查，23项研究纳入本研究。纳入了量化阿片类药物使用情况（开具的药丸数量、吗啡当量、处方 refill）的研究。阿片类药物处方范围各不相同，存在过度开具和开具不足的倾向；因此，无法得出结论。本综述强调需要考虑个体患者的疼痛需求，并表明需要更高质量的文献来帮助制定指南。
