Quantifying the use of opioids in the immediate postoperative period after endoscopic sinus surgery.

Autor: Badash I; Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A., Lui CG; Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A., Hur K; Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A., Acevedo JR; Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A., Ference EH; Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A., Wrobel BB; Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2020 May; Vol. 130 (5), pp. 1122-1127. Date of Electronic Publication: 2019 Jul 24.
DOI: 10.1002/lary.28178
Abstrakt: Objectives/hypothesis: The opioid crisis is a public health emergency. There is limited evidence regarding how much opioid medication is necessary and which patients will require additional pain medication following endoscopic sinus surgery (ESS). The objective of this study was to quantify the use of opioids in the first 24 hours following ESS and determine the risk factors associated with increased need for opioid analgesia.
Study Design: Retrospective chart review.
Methods: A review of opioid-naïve patients routinely admitted to the hospital following ESS between June 2016 and August 2018 was performed. Opioid consumption was quantified for each patient and converted to a morphine milligram equivalents (MME) dose. Pain intensity scores were also recorded throughout the postoperative period. Sociodemographic characteristics as well as surgical procedures performed were evaluated for impact on MME.
Results: A total of 130 patients (45.4% female) were included for analysis. The mean opioid dose consumed per patient in the first 24 hours following ESS was 24.1 MME, and the mean pain intensity was 2.4/10. Increasing pain scores were strongly associated with increasing MME (R = 0.78, P < .001). Multiple linear regression identified that patients taking antidepressants required an additional 17.2 MME (95% confidence interval [CI]: 5.5-28.9, P = .004) in the first 24 hours following ESS, whereas patients undergoing papilloma resection required an additional 16.9 MME (95% CI: 2.5-31.4, P = .022).
Conclusions: Patients undergoing ESS require different amounts of opioids for pain control in the immediate postoperative period. A history of antidepressant use and inverted papilloma resection during ESS were associated with increased opioid consumption postoperatively.
Level of Evidence: 4 Laryngoscope, 130:1122-1127, 2020.
(© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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