通过消除阴茎反转阴道成形术（增强术后恢复（ERAS）方案）后患者自控镇痛（PCA）来减少阿片类药物的消耗。
Minimizing opioid consumption by eliminating patient-controlled analgesia after penile inversion vaginoplasty with enhanced recovery after surgery (ERAS) protocol.
机构信息
Georgetown University School of Medicine, Washington, District of Columbia, USA.
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
出版信息
Andrology. 2022 Feb;10(2):232-240. doi: 10.1111/andr.13095. Epub 2021 Aug 24.
BACKGROUND
Genital-based gender affirmation surgery is a physically demanding procedure requiring extensive postoperative pain management. However, perioperative opioid use for these procedures is relatively understudied.
OBJECTIVES
This study analyzes whether intravenous patient-controlled analgesia (PCA) enhances pain control after penile inversion vaginoplasty (PIV) in the setting of enhanced recovery after surgery (ERAS) protocols, and whether non-PCA (NCA)-based regimens could reduce postoperative opioid use.
METHODS
All patients undergoing PIV with ERAS protocols by a single provider from December 2018 to November 2020 were retrospectively reviewed. Patient demographics, comorbid conditions, pain scores, length of stay (LOS), and opioid usage during their hospitalization were collected. Postoperative opioid use and pain scores were compared between PCA and NCA patient cohorts.
RESULTS
A total of 61 patients were included. 30 patients received intravenous PCA postoperatively, and 31 patients used NCA-based narcotic pain control. All patients underwent ERAS protocol perioperatively. Average patient age was 34.5 years (SD 11.9) in the PCA cohort and 37.6 years (SD 11.9) in the NCA cohort (p = 0.242). Average total postoperative opioid use during hospital stay was reduced by 53.7% in the NCA cohort, with an average use of 501.6 morphine milligram equivalents (MME) (SD 410.3) among PCA patients and an average use of 232.0 MME (SD 216.5) among NCA patients (p = 0.003). Daily average pain scores for postoperative days 1 to 6 did not differ between the PCA and NCA patient groups (p > 0.05). Average hospital LOS was shorter among NCA patients, 6.2 days (SD 1.0) versus 7.3 days (SD 1.4), respectively, (p < 0.001).
DISCUSSION
In combination with an ERAS non-narcotic pain control protocol, it may be possible to reduce opioid use by more than 50% and shorten length of postoperative hospital stay among patients by implementing NCA pain management protocols.
CONCLUSION
Minimizing postoperative opioid consumption after PIV will benefit patients and their sustained well-being.
背景
生殖器性别肯定手术是一种体力要求很高的手术，需要进行广泛的术后疼痛管理。然而，这些手术的围手术期阿片类药物使用相对研究不足。
目的
本研究分析在增强术后恢复（ERAS）方案中，静脉患者自控镇痛（PCA）是否能增强阴茎反转阴道成形术（PIV）后的疼痛控制，以及非 PCA（NCA）方案是否能减少术后阿片类药物的使用。
方法
回顾性分析 2018 年 12 月至 2020 年 11 月由一名医生进行的所有接受 PIV 手术并采用 ERAS 方案的患者。收集患者的人口统计学、合并症、疼痛评分、住院时间（LOS）和住院期间的阿片类药物使用情况。比较 PCA 和 NCA 患者队列的术后阿片类药物使用和疼痛评分。
结果
共纳入 61 例患者。30 例患者术后接受静脉 PCA，31 例患者使用 NCA 类阿片类药物进行疼痛控制。所有患者均在围手术期接受 ERAS 方案。PCA 组患者平均年龄为 34.5 岁（SD 11.9），NCA 组为 37.6 岁（SD 11.9）（p=0.242）。NCA 组患者术后住院期间的总术后阿片类药物使用量减少了 53.7%，PCA 组患者的平均使用量为 501.6 吗啡毫克当量（MME）（SD 410.3），NCA 组患者的平均使用量为 232.0 MME（SD 216.5）（p=0.003）。术后第 1 至 6 天的每日平均疼痛评分在 PCA 和 NCA 患者组之间没有差异（p>0.05）。NCA 组患者的平均住院时间较短，分别为 6.2 天（SD 1.0）和 7.3 天（SD 1.4）（p<0.001）。
讨论
与 ERAS 非阿片类药物疼痛控制方案相结合，通过实施 NCA 疼痛管理方案，可能会减少超过 50%的阿片类药物使用，并缩短术后住院时间。
结论
减少 PIV 后的术后阿片类药物消耗将使患者及其持续的幸福感受益。
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