Postdischarge Opioid Use After Cesarean Delivery
Postdischarge Opioid Use After Cesarean Delivery
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DOI：
10.1097/aog.0000000000002095
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发表时间：
2017-07-01
影响因子：
7.2
通讯作者：
Richardson, Michael G.
中科院分区：
文献类型：
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作者：
Osmundson, Sarah S.;Schornack, Leslie A.;Richardson, Michael G.
目的：为了表征出院后阿片类药物的使用，并检查与阿片类药物处方和consumption.METHODS的变化相关的因素：我们进行了一项前瞻性观察性队列研究，招募所有妇女接受剖宫产在8周的时间内，不包括那些主要的术后发病率或慢性阿片类药物的使用。从术后第14天开始，每周询问女性使用的阿片类药物数量，剩余数量以及他们的疼痛体验，直到他们停止阿片类药物治疗。记录人口统计学和分娩信息以及住院阿片类药物使用情况。访问了州物质监测计划，以确定处方填写细节。计算吗啡毫克当量以进行阿片类药物使用比较。将阿片类药物使用最高四分位数（阿片类药物使用最高四分位数）的女性与最低三个四分位数（阿片类药物使用平均值）的女性进行比较。179例患者（71%的合格患者）获得了完整的随访数据。大多数女性（83%）在出院后使用阿片类药物的中位数为8天（四分位数间距为6-13天）。在填写处方的女性中（165 [92%]），75%有未使用的片剂（每人平均75毫克吗啡当量，四分位数范围0-187，最大630），大多数（63%）将片剂储存在未锁定的位置。这相当于在我们的研究期间有2，540片未使用的5 mg羟考酮片剂。使用所有处方阿片类药物的女性（n=40 [22%]）比使用一些（n=109 [61%]）或不使用（n=30 [17%]）处方阿片类药物的女性更有可能报告他们接受的片剂太少（33%与4%相比，5%，P，. 001）。与普通使用者相比，前四分位数更有可能是吸烟者，并且与普通阿片类药物使用者相比，每小时住院时间消耗更多的阿片类吗啡毫克当量（1.6，四分位数范围1.1-2.3与1.0，四分位数范围0.5-1.4，P
OBJECTIVE: To characterize postdischarge opioid use and examine factors associated with variation in opioid prescribing and consumption.METHODS: We conducted a prospective observational cohort study by recruiting all women undergoing cesarean delivery during an 8-week period, excluding those with major postoperative morbidities or chronic opioid use. Starting on postoperative day 14, women were queried weekly regarding number of opioid pills used, amount remaining, and their pain experience until they had stopped opioid medication. Demographic and delivery information and in-hospital opioid use were recorded. The state Substance Monitoring Program was accessed to ascertain prescription-filling details. Morphine milligram equivalents were calculated to perform opioid use comparisons. Women in the highest quartile of opioid use (top opioid quartile use) were compared with those in the lowest three quartiles (average opioid use).RESULTS: Of 251 eligible patients, 246 (98%) agreed to participate. Complete follow-up data were available for 179 (71% of eligible). Most women (83%) used opioids after discharge for a median of 8 days (interquartile range 6-13 days). Of women who filled their prescriptions (165 [92%]), 75% had unused tablets (median per person 75 morphine milligram equivalents, interquartile range 0-187, maximum 630) and the majority (63%) stored tablets in an unlocked location. This amounts to an equivalent of 2,540 unused 5-mg oxycodone tablets over our study period. Women who used all prescribed opioids (n=40 [22%]) were more likely to report that they received too few tablets than women who used some (n=109 [61%]) or none (n=30 [17%]) of the prescribed opioids (33% compared with 4% compared with 5%, P,. 001). The top quartile was more likely to be smokers than average users and consumed more opioid morphine milligram equivalents per hour of inpatient stay than average opioid users (1.6, interquartile range 1.1-2.3 compared with 1.0, interquartile range 0.5-1.4, P