Multimodal analgesia after thyroid or parathyroid surgery: A randomized controlled trial.

Autor: Romero Arenas MA; Department of Surgery, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX. Electronic address: minerva.romeroarenas@utrgv.edu., Uhlmann RA; Department of Surgery, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX., Postevka E; School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX., Wang X; School of Mathematical and Statistical Sciences, University of Texas Rio Grande Valley, Edinburg, TX., Reinhart HA 3rd; Department of Surgery, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX., Snyder SK; Department of Surgery, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2021 Mar; Vol. 169 (3), pp. 508-512. Date of Electronic Publication: 2020 Sep 22.
DOI: 10.1016/j.surg.2020.08.008
Abstrakt: Background: The opioid epidemic prompted reevaluation of surgeons' opioid prescribing practices. This study aimed to demonstrate noninferiority of a staged analgesic regimen after endocrine surgery.
Methods: We conducted a randomized controlled trial comparing analgesic regimens after thyroidectomy and/or parathyroidectomy. Adult patients (≥18 years) were randomized to study arm (A) as-needed acetaminophen + codeine or (B) scheduled acetaminophen/as-needed tramadol. Patients recorded pain scores and analgesics consumed in a study log. Clinical variables were collected from the medical record.
Results: Target enrollment was achieved (n = 126), and randomization was even (A: 44.5%, B: 55.6%). There was no difference between enrolled patients and those who returned the study log (52.4%) by sex (P = .667), age (P = .513), final pathology (P = .137), procedure (P = .667), or randomization arm (P = .795). Most patients (50.8%) reported moderate pain scores (4-6) with no difference between study arms (P = .451). There was no difference in average consumption by morphine milligram equivalents (A: 11.5 ± 12.1 vs B: 12.49 ± 18.07; P = .792) nor total analgesic doses (A: 7.29 ± 7.48 vs B: 8.5 ± 5.36; P = .445). However, a significant difference in average percentage of opioid doses was noted (A: 79.71 ± 33.31 vs B: 27.38 ± 31.88; P < .001).
Conclusion: Patients reported moderate pain scores with low requirements for analgesics after endocrine surgery. The staged analgesic regimen is noninferior to combination opioids and led to reduced overall consumption.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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