The Association between Implementation of an Enhanced Recovery after Cesarean Pathway with Standardized Discharge Prescriptions and Opioid Use and Pain Experience after Cesarean Delivery.
The Association between Implementation of an Enhanced Recovery after Cesarean Pathway with Standardized Discharge Prescriptions and Opioid Use and Pain Experience after Cesarean Delivery.
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DOI：
10.1055/s-0041-1732378
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发表时间：
2021-11
影响因子：
2
通讯作者：
Srinivas, Sindhu K.
中科院分区：
文献类型：
--
作者：
McCoy, Jennifer A.;Gutman, Sarah;Hamm, Rebecca F.;Srinivas, Sindhu K.
这项研究的目的是评估剖腹产（CD）后阿片类药物的使用，并评估增强CD后恢复（ERAS-CD）途径的实施及其与住院和出院后疼痛控制和阿片类药物使用的相关性。我们对2017年1月至3月在一家城市学术医院接受CD的女性进行了基线调查。患者在出院后5至8天被打电话询问他们的疼痛和出院后阿片类药物的使用情况。实施ERAS-CD途径作为质量改进举措，包括使用非阿片类镇痛和阿片类药物出院处方标准化至≤ 25片5 mg羟考酮。从11月到2019年1月，进行了一项实施后调查，以评估这一举措与患者疼痛控制和术后阿片类药物使用之间的关系，包括住院和出院后。数据来自152名妇女preimplementation（PRE）和137名妇女postimplementation（POST）;完整的调查数据来自102名妇女PRE和98名妇女POST。每例患者消耗的中位住院吗啡毫克当量从141 [范围：90 - 195] PRE显著降低至114 [范围：45 - 168] POST（p = 0.002）。在0 - 10分量表上，出院时患者报告的疼痛评分中位数显著降低（PRE：7 [范围：5 - 8] vs. POST 5 [范围：3 - 7]，p <0.001）。出院后服用的药丸中位数也显著降低（PRE：25 [范围：16 - 30] vs. POST 17.5 [范围：4 - 25]，p = 0.001）。服用的药丸数量与处方数量显著相关（p <0.001），剩余药丸的中位数和续药的数量在两组之间没有显著差异。POST组出院后一周患者报告的疼痛评分中位数较低（PRE：4 [范围：2 - 6] vs. POST 3 [范围：1 - 5]，p = 0.03）。实施ERAS-CD途径与住院患者和出院后阿片类药物消耗的显著减少相关，同时改善疼痛控制。我们的数据表明，甚至更少的药丸可以为一些患者开处方。
This study was aimed to evaluate opioid use after cesarean delivery (CD) and to assess implementation of an enhanced recovery after CD (ERAS-CD) pathway and its association with inpatient and postdischarge pain control and opioid use. We conducted a baseline survey of women who underwent CD from January to March 2017 at a single, urban academic hospital. Patients were called 5 to 8 days after discharge and asked about their pain and postdischarge opioid use. An ERAS-CD pathway was implemented as a quality improvement initiative, including use of nonopioid analgesia and standardization of opioid discharge prescriptions to ≤25 tablets of oxycodone of 5 mg. From November to January 2019, a postimplementation survey was conducted to assess the association between this initiative and patients’ pain control and postoperative opioid use, both inpatient and postdischarge. Data were obtained from 152 women preimple mentation (PRE) and 137 women postimplementation (POST); complete survey data were obtained from 102 women PRE and 98 women POST. The median inpatient morphine milligram equivalents consumed per patient decreased significantly from 141 [range: 90–195] PRE to 114 [range: 45–168] POST(p= 0.002). On a 0- to 10-point scale, median patient-reported pain scores at discharge decreased significantly (PRE: 7 [range: 5–8] vs. POST 5 [range: 3–7], p < 0.001). The median number of pills consumed after discharge also decreased significantly (PRE: 25 [range: 16–30] vs. POST 17.5 [range: 4–25], p= 0.001). The number of pills consumed was significantly associated with number prescribed (p< 0.001).The median number of leftover pills and number of refills did not significantly differ between groups. Median patient-reported pain scores at the week after discharge were lower in the POST group (PRE: 4 [range: 2–6] vs. POST 3[range: 1–5], p = 0.03). Implementing an ERAS-CD pathway was associated with a significant decrease in inpatient and postdischarge opioid consumption while improving pain control. Our data suggest that even fewer pills could be prescribed for some patients.
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影响因子：
6.3
作者：
Lam L;Richardson MG;Zhao Z;Thampy M;Ha L;Osmundson SS
通讯作者：
Osmundson SS
影响因子：
7.2
作者：
Johnson, Jasmine D.;Asiodu, Ifeyinwa V.;Stuebe, Alison M.
通讯作者：
Stuebe, Alison M.
影响因子：
13.8
作者：
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通讯作者：
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影响因子：
7.2
作者：
Smith, Alisha M.;Young, Paul;Poole, Aaron T.
通讯作者：
Poole, Aaron T.
影响因子：
7.2
作者：
Mullman L;Hilden P;Goral J;Gwacham N;Tauro C;Spinola K;Rosales K;Collier S;Holmes L;Maccione J;Pitera R;Miller R;Yodice P
通讯作者：
Yodice P