Reducing Opioid Prescriptions in Outpatient Pediatric Urological Surgery
Reducing Opioid Prescriptions in Outpatient Pediatric Urological Surgery
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DOI：
10.1097/ju.0000000000000020
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发表时间：
2019-05-01
影响因子：
6.6
通讯作者：
Chiang, George
中科院分区：
文献类型：
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作者：
Cardona-Grau, Diana;Bush, Ruth A.;Chiang, George
目的：我们评估了两阶段计划-实施-研究-行动周期对减少儿科泌尿外科手术后阿片类药物处方的影响。材料和方法：对接受门诊泌尿外科手术的儿童的家长进行问卷调查，以使用家长术后疼痛测量量表评估阿片类药物剂量和疼痛评分。记录年龄、手术和阿片类药物处方数据，以及给药量。在数据收集的第一阶段，儿童接受了 10 剂阿片类药物处方。在第二阶段，阿片类药物处方减少了 50%。采用非参数检验和 Fisher 精确检验进行分析。结果：250 名符合条件的儿童中，有 98 名（39%）中位年龄为 3.0 岁（IQR 7.0）参与。在 81 名服用阿片类药物的患者中，干预前组和干预后组使用中位数为 2 剂（IQR 3.6）（p = 0.68）。使用非参数统计检验，5 剂组（31 名患者）和 10 剂组（24 名患者；第 1 天 p = 0.05，第 2 天 p = 0.07，第 3 天 p = 0.06）之间的疼痛评分没有发现显着差异。年龄和阿片类药物使用百分比之间没有关联（p = 0.83）。手术类型之间的中位疼痛评分或中位剂量没有显着差异。结论：在门诊儿科手术实践中，可以减少阿片类药物处方而不增加疼痛评分。医生的处方做法可能比实际的疼痛模式更能促进阿片类药物的消耗。
Purpose: We assessed the impact of a 2-phase Plan-Do-Study-Act cycle to decrease opioid prescriptions following pediatric urological surgery.Materials and Methods: Parents of children undergoing outpatient urological procedures were given questionnaires to assess opioid dosing and pain scores using the Parents' Postoperative Pain Measure scale. Age, procedure and opioid prescription data were recorded, as well as volume of medication administered. During the first phase of data collection children received an opioid prescription for 10 doses. In the second phase opioid prescriptions were reduced by 50%. Nonparametric tests and Fisher exact test were used for analysis.Results: Of 250 eligible children 98 (39%) with a median age of 3.0 years (IQR 7.0) participated. In the 81 patients prescribed opioids a median of 2 doses (IQR 3.6) were used in the preintervention and postintervention groups (p = 0.68). Using nonparametric statistical testing, no significant differences were found between pain scores in the 5-dose group (31 patients) and the 10-dose group (24 patients; p = 0.05 for day 1, p = 0.07 for day 2, p = 0.06 for day 3). There was no association between age and percent opioid used (p = 0.83). There were no significant differences in median pain scores or median doses among procedure types.Conclusions: In outpatient pediatric surgical practice opioid prescriptions can be decreased without increasing pain scores. Physician prescribing practices may contribute more to opioid consumption than actual pain patterns.