Can aggressive postoperative non-narcotic therapy replace narcotics in patients undergoing laparoscopic hysterectomies?
Notice bibliographique
Résumé
Pain, although invariably present after surgical procedures, is not always well controlled. Medications from different analgesic groups are often used to control post-operative pain. Recently, attention has turned towards the optimization of non-opioid analgesics including NSAIDS and acetaminophen. After gynaecologic laparoscopy up to 80% of patients may require opioid analgesia. However, opioids can have adverse effects including nausea, vomiting, sedation, and respiratory depression. Thus the prudent surgeon attempts to use a narcotic-sparing approach to post-operative analgesia. Theoretically, aggressive non-narcotic analgesic administration will result in less narcotic use. Fortunately, both NSAIDs and acetaminophen are very effective in the control of moderate to severe pain and have few side effects. Our research question then is: “What is the post-operative narcotic use amongst women undergoing laparoscopic hysterectomy who receive aggressive non-narcotic therapy?” The subjects of interest were undergoing laparoscopic hysterectomy in a Canadian community hospital. Data from one calendar year was reviewed. For all patients the same routine pre-printed orders were used by the nursing staff. The order set included non-prn (non-discretionary) post-operative non-narcotic analgesics (ketorolac and acetaminophen). Narcotics were administered by the nursing staff on a prn basis for non-response/breakthrough pain after administration of the non-narcotic analgesics. Two databases, Meditech® and OR Manager® were used to extract information. Medication administration was determined from the Meditech® “Medications” module. Only ward administration of narcotics was included. All narcotics were converted to IV-morphine equivalents using Canadian Pharmacist Association (2008) morphine-centric equi-analgesic conversions. The data was tabulated and analyzed using Microsoft Excel. Two hundred sixteen women underwent laparoscopic hysterectomy in the year ending July 30 2013. Meperedine, morphine, codeine, tramadol, and oxycodone were the narcotics administered. Overall, only 29% of the patients received narcotics. The mean narcotic dose in those patients who received narcotics was 4.1 morphine-equivalent mgs IV. Of those who received post-op narcotics 22% did so between hours 0 and 6 and 23% between hours 6 and 12. When between-surgeon comparison was performed there was marked variation in narcotic consumption by patients ranging from approximately 20% to 40%. Most (71%) women in this laparoscopic hysterectomy cohort did not receive any narcotics. This is likely attributable to the aggressive use of non-narcotic analgesics. There was unexplained between-surgeon variability in patient narcotic usage. Routine non-prn (non-discretionary) order sets offer an attractive therapeutic option for the management of post-op pain.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».