Decreasing Inpatient Opioid Use Following Orthognathic Surgery.
| Autor: | Phillips SJ; Plastic and Oral and Maxillofacial SUrgery, Yale New Haven Health, New Haven CT., Peck CJ, Pourtaheri N, Reategui A, Carney M, Dinis J, Park KE, Maniskas S, Lopez J, Steinbacher DM |
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| Jazyk: | angličtina |
| Zdroj: | The Journal of craniofacial surgery [J Craniofac Surg] 2021 Nov-Dec 01; Vol. 32 (8), pp. 2808-2811. |
| DOI: | 10.1097/SCS.0000000000008001 |
| Abstrakt: | Purpose: Strategies to decrease postoperative opioid use are important for mitigating the immediate and long-term risks associated with their use. We aimed to investigate the impact of perioperative various factors on inpatient opioid needs for patients undergoing orthognathic surgery. Methods: This was a retrospective cohort study of all patients who underwent orthognathic surgery performed by the senior author from 2012 to 2018. Patients were grouped into intravenous (IV) acetaminophen and no-IV acetaminophen cohorts. Opioid medications received by patients during hospital stay were converted to mean morphine equivalents (MME) for comparison. Additional factors that influenced opioid consumption, such as transexamic acid (TXA) and postoperative nausea and vomiting (PONV), were identified using univariate analysis. Factors found to have statistical significance were added to a multivariate linear regression model. Results: 319 patients were included. Those who received IV acetaminophen had lower rates of total opioid use (57.3 versus 74.8 MME; P = 0.002) and postoperative opioid use (24.0 versus 37.7 MME; P < 0.001). Perioperative prothrombotic agents, such as TXA, were associated with lower total and postoperative MME (P = 0.005, P = 0.002). Multivariate regression analysis showed that increased PONV resulted in increased postoperative opioid use, whereas perioperative acetaminophen lowered total and postoperative quantities. Conclusions: Perioperative IV acetaminophen is an effective method for decreasing inpatient opioid analgesia after orthognathic surgery. Intravenous TXA and PONV control may provide additional benefit to decreasing inpatient opioid consumption. More research as to the mechanisms and ideal clinical applications for both IV acetaminophen and TXA are warranted. Competing Interests: The authors report no conflicts of interest. (Copyright © 2021 by Mutaz B. Habal, MD.) |
| Databáze: | MEDLINE |
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