{"title":"腹腔镜子宫切除术后阿片类药物使用增加的术中因素。","authors":"Wenjia Zhang, Valencia Miller, Marron Wong, Megan Loring, Stephanie Morris","doi":"10.4293/JSLS.2022.00028","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>To identify intraoperative factors during laparoscopic hysterectomy associated with postoperative opioid use and increased pain scores during the acute postoperative period.</p><p><strong>Methods: </strong>This is a prospective survey-based cohort study at two teaching hospitals in the Boston metropolitan area. A total of 125 patients undergoing laparoscopic hysterectomy were enrolled. Surveys were administered by telephone at one-week postoperatively and in-person at their two-week postoperative visit to elicit opioid consumption converted to morphine milligram equivalents (MMEs) and pain scores.</p><p><strong>Results: </strong>The median total opioid consumption was 37.5 MME (range 0-960 MMEs). Intraoperative factors associated with increased total MME consumption were lower uterine weight and resection of endometriosis at the time of surgery. Patients with uteri less than 250 grams used twice as much opioid compared to participants with uteri greater than 250 grams (median of 49.8 MME (interquartile range [IQR] 7.5-120.5) vs. 22.5 MME (IQR 7.5-61.0). The median opioid consumption by patients with resection or ablation of endometriosis was three times that of those who did not undergo surgical treatment of endometriosis (97.0 MME (IQR 53.1-281.3) vs. 30.0 MMEs (IQR 7.5-81.3 MME)). Maximum pain scores and reported pain score at one and two-week interviews were also significantly higher in patients with these characteristics.</p><p><strong>Conclusion: </strong>Several easily identified intraoperative factors may be correlated with opioid requirements during the acute postoperative period. This can allow surgeons to set expectations and dispense patient-specific opioid prescriptions. Individualizing prescriptions may lower the amount of excess circulating opioids and help combat the opioid epidemic.</p>","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":" ","pages":""},"PeriodicalIF":16.4000,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fa/9b/e2022.00028.PMC9355794.pdf","citationCount":"3","resultStr":"{\"title\":\"Intraoperative Factors Associated with More Postoperative Opioid Use after Laparoscopic Hysterectomy.\",\"authors\":\"Wenjia Zhang, Valencia Miller, Marron Wong, Megan Loring, Stephanie Morris\",\"doi\":\"10.4293/JSLS.2022.00028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>To identify intraoperative factors during laparoscopic hysterectomy associated with postoperative opioid use and increased pain scores during the acute postoperative period.</p><p><strong>Methods: </strong>This is a prospective survey-based cohort study at two teaching hospitals in the Boston metropolitan area. A total of 125 patients undergoing laparoscopic hysterectomy were enrolled. Surveys were administered by telephone at one-week postoperatively and in-person at their two-week postoperative visit to elicit opioid consumption converted to morphine milligram equivalents (MMEs) and pain scores.</p><p><strong>Results: </strong>The median total opioid consumption was 37.5 MME (range 0-960 MMEs). Intraoperative factors associated with increased total MME consumption were lower uterine weight and resection of endometriosis at the time of surgery. Patients with uteri less than 250 grams used twice as much opioid compared to participants with uteri greater than 250 grams (median of 49.8 MME (interquartile range [IQR] 7.5-120.5) vs. 22.5 MME (IQR 7.5-61.0). The median opioid consumption by patients with resection or ablation of endometriosis was three times that of those who did not undergo surgical treatment of endometriosis (97.0 MME (IQR 53.1-281.3) vs. 30.0 MMEs (IQR 7.5-81.3 MME)). Maximum pain scores and reported pain score at one and two-week interviews were also significantly higher in patients with these characteristics.</p><p><strong>Conclusion: </strong>Several easily identified intraoperative factors may be correlated with opioid requirements during the acute postoperative period. This can allow surgeons to set expectations and dispense patient-specific opioid prescriptions. Individualizing prescriptions may lower the amount of excess circulating opioids and help combat the opioid epidemic.</p>\",\"PeriodicalId\":1,\"journal\":{\"name\":\"Accounts of Chemical Research\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":16.4000,\"publicationDate\":\"2022-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fa/9b/e2022.00028.PMC9355794.pdf\",\"citationCount\":\"3\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Accounts of Chemical Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4293/JSLS.2022.00028\",\"RegionNum\":1,\"RegionCategory\":\"化学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CHEMISTRY, MULTIDISCIPLINARY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4293/JSLS.2022.00028","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}
Intraoperative Factors Associated with More Postoperative Opioid Use after Laparoscopic Hysterectomy.
Background and objectives: To identify intraoperative factors during laparoscopic hysterectomy associated with postoperative opioid use and increased pain scores during the acute postoperative period.
Methods: This is a prospective survey-based cohort study at two teaching hospitals in the Boston metropolitan area. A total of 125 patients undergoing laparoscopic hysterectomy were enrolled. Surveys were administered by telephone at one-week postoperatively and in-person at their two-week postoperative visit to elicit opioid consumption converted to morphine milligram equivalents (MMEs) and pain scores.
Results: The median total opioid consumption was 37.5 MME (range 0-960 MMEs). Intraoperative factors associated with increased total MME consumption were lower uterine weight and resection of endometriosis at the time of surgery. Patients with uteri less than 250 grams used twice as much opioid compared to participants with uteri greater than 250 grams (median of 49.8 MME (interquartile range [IQR] 7.5-120.5) vs. 22.5 MME (IQR 7.5-61.0). The median opioid consumption by patients with resection or ablation of endometriosis was three times that of those who did not undergo surgical treatment of endometriosis (97.0 MME (IQR 53.1-281.3) vs. 30.0 MMEs (IQR 7.5-81.3 MME)). Maximum pain scores and reported pain score at one and two-week interviews were also significantly higher in patients with these characteristics.
Conclusion: Several easily identified intraoperative factors may be correlated with opioid requirements during the acute postoperative period. This can allow surgeons to set expectations and dispense patient-specific opioid prescriptions. Individualizing prescriptions may lower the amount of excess circulating opioids and help combat the opioid epidemic.
期刊介绍:
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.