Narcotic Free Cervical Endocrine Surgery A Shift in Paradigm
Narcotic Free Cervical Endocrine Surgery A Shift in Paradigm
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DOI：
10.1097/sla.0000000000003443
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发表时间：
2021-08-01
影响因子：
9
通讯作者：
Moalem, Jacob
中科院分区：
文献类型：
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作者：
Ruffolo, Luis I.;Jackson, Katherine M.;Moalem, Jacob
背景和目的：阿片类药物的流行刺激了减少不必要麻醉处方数量的举措。我们为接受非卧床宫颈内分泌手术(CES)的患者采用了选择加入处方系统。我们假设，授权患者决定是否接受止痛麻醉药将导致更少不必要的阿片类药物处方。方法：我们将计划在2017年7月至2018年6月期间进行CES门诊治疗的所有患者纳入麻醉药品选择计划。前瞻性收集患者的人口统计学、手术特点和术后疼痛评分。进行统计分析，以将临床预测因素与麻醉请求相关联。将结果与历史对照组进行比较。这项研究得到了大学IRB的批准。结果：在该计划实施后，共有216名患者接受了门诊CES。只有9人(4%)在出院时要求处方麻醉剂药物，没有患者在出院后打电话要求止痛药。与我们之前的治疗方案相比，我们的麻醉剂处方数量减少了96.6%，未消费的药片减少了98%。单因素分析显示，药物滥用史(P<；0.001)、焦虑史(P=0.10)、抑郁史(P<；0.001)、基线麻醉用药史(P=0.004)、术后最大疼痛史(P=0.004)和切口长(P=0.007)是麻醉请求的预测因素。多因素分析显示切口长度和药物滥用史有统计学意义。结论：通过允许接受或拒绝门诊CES的患者接受或拒绝处方，我们减少了96.6%的处方麻醉药。虽然较长的切口和既往药物滥用预示着出院时要求止痛药的可能性更高，但216名患者中有207名仅接受对乙酰氨基酚治疗。
Background and Objective: The opioid epidemic has stimulated initiatives to reduce the number of unnecessary narcotic prescriptions. We adopted an opt-in prescription system for patients undergoing ambulatory cervical endocrine surgery (CES). We hypothesized that empowering patients to decide whether or not to receive narcotics for pain control would result in fewer unnecessary opioid prescriptions. Methods: We enrolled all patients scheduled for outpatient CES between July 2017 and June 2018 in a narcotic opt-in program. Patient demographics, procedure characteristics, and postoperative pain scores were collected prospectively. Statistical analyses were performed to correlate clinical predictors with narcotic request. Results were compared against a historical control group. The study was approved by the University IRB. Results: A total of 216 consecutive patients underwent outpatient CES following implementation of the program. Only nine (4%) requested prescription narcotic medication at discharge, and no patient called after discharge to request analgesic medications. Compared with our prior treatment paradigm, we achieved a 96.6% reduction in the number of narcotic tablets prescribed, and a 98% reduction in unconsumed tablets. Univariate analysis suggested history of substance abuse (P < 0.001), anxiety (P = 0.01), depression (P < 0.001), baseline narcotic use (P = 0.004), highest pain postoperatively (P = 0.004), and incision length (P = 0.007) as predictive for narcotic request. Multivariate analysis retained significance with incision length and history of substance abuse. Conclusion: By empowering patients undergoing ambulatory CES to accept or decline a prescription, we reduced the number of prescribed narcotic tablets by 96.6%. Although longer incisions and prior substance abuse predict higher likelihood of requesting pain medication on discharge, 207 of 216 patients were treated with acetaminophen alone.