Schmerztherapie ohne Opioide nach roboterassistierten Eingriffen


Die Mehrheit der Patienten benötigt nach roboterassistierten Eingriffen keine Opioide. Dies schließen US-amerikanische Urologen aus einer prospektiven Studie an ihrer Institution in Philadelphia.

Die Implementierung eines einfachen, standardisierten Nicht-Opioid-Protokolls führte zu einer dramatischen Reduzierung der Menge an Opioiden, die in der Patientenpopulation verschrieben wurden.

Vor 9/2018 entließen die Urologen alle Patienten mit unterschiedlichen Mengen Oxycodon (Bereich: 75–337,5 orale Morphin-Milligramm-Äquivalente [MME]). Dann implementierten sie einen standardisierten Nichtopioid-Analgesie-Weg mit Eskalationsoptionen. Um die Sicherheit dieses Ansatzes zu beurteilen, analysierten sie Schmerzwerte, telefonische Konsultationen und Besuche in der Notaufnahme.

Von den insgesamt 170 Patienten erhielten 87 eine radikale Prostatektomie, 25 eine radikale Nephrektomie und 58 eine partielle Nephrektomie, jeweils mit Roboterunterstützung, im Zeitraum 9/2018 bis 1/2019. Insgesamt wurden 67,7 % ohne Opioide entlassen. 24,4 % erhielten 10 Tabletten Tramadol (50 MME) und 8,2 % 10 Tabletten Oxycodon (75 MME). Bei einer multivariablen Analyse war höheres Alter (OR: 0,961; 95 %-KI: 0,923–0,995; p=0,026) mit einer geringeren Wahrscheinlichkeit verbunden, bei der Entlassung Opioide zu benötigen. Es gab keinen Unterschied in den Schmerzwerten beim postoperativen ambulanten Besuch (p=0,66) oder bei postoperativen telefonischen Konsultationen (p=0,45) zwischen Patienten, die mit und ohne Opioide entlassen wurden. (ms)

Publikation:

Talwar R et al. Preventing Excess Narcotic Prescriptions in New Robotic Surgery Discharges: The PENN Prospective Cohort Quality Improvement Initiative. J Endourol 2020 Jan;34(1):48–53.

Der Beitrag Schmerztherapie ohne Opioide nach roboterassistierten Eingriffen erschien zuerst auf Biermann Medizin.

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