Aasvang E K, Lunn T H, Hansen T B, Kristensen P W, Solgaard S, Kehlet H
Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
The Lundbeck Centre for fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2016 Apr;60(4):529-36. doi: 10.1111/aas.12667. Epub 2015 Dec 28.
Pre-operative opioid use has been suggested to increase post-operative pain and opioid consumption after total knee arthroplasty (TKA), but previous studies are either retrospective or inhomogeneous with regard to surgical procedures or control of analgesic regimes, or with few opioid-treated patients, hindering firm conclusions.
In a prospective observational study, we investigated the effect of > 4 weeks pre-operative opioid use [none vs. low dose (< 30 mg morphine equivalents (eq.)) vs. high dose (> 30 mg morphine eq.] in patients scheduled for primary, unilateral TKA. All patients had well-defined multimodal opioid-sparring perioperative analgesic therapy, and continued any pre-operative opioid medication. The primary outcome was differences between groups in pain at rest and during walk for the first 6 post-operative days.
Among 123 patients included, 115 were available for final analysis (93% follow-up rate). Post-operative pain during walk was significantly increased in both opioid-treated groups vs. non-opioid-treated patients (P < 0.009). Secondary analysis of combining all pre-operatively opioid-treated patients vs. opioid-free patients, showed significantly increased pain at rest and walk and increased post-operative opioid requirement - excluding pre-operative dosage - during the first post-operative week in opioid-treated patients (P = 0.001 and P = 0.007, respectively).
Pre-operative opioid use increases the risk for post-operative pain at rest and walk, and increased opioid consumption after TKA.
术前使用阿片类药物被认为会增加全膝关节置换术（TKA）后的术后疼痛及阿片类药物消耗量，但既往研究在手术操作、镇痛方案控制方面存在回顾性或不均衡性，或者接受阿片类药物治疗的患者较少，这妨碍了得出确切结论。
在一项前瞻性观察性研究中，我们调查了术前使用阿片类药物超过4周[未使用 vs. 低剂量（<30毫克吗啡当量（eq.）） vs. 高剂量（>30毫克吗啡eq.）]对计划进行初次单侧TKA患者的影响。所有患者均接受明确的多模式阿片类药物节省围手术期镇痛治疗，并继续使用任何术前阿片类药物。主要结局是术后前6天各治疗组在静息和行走时疼痛的差异。
纳入的123例患者中，115例可进行最终分析（随访率93%）。与未接受阿片类药物治疗的患者相比，两个接受阿片类药物治疗的组在行走时的术后疼痛均显著增加（P<0.009）。将所有术前接受阿片类药物治疗的患者与未使用阿片类药物的患者合并进行的二次分析显示，在术后第一周，接受阿片类药物治疗的患者静息和行走时的疼痛显著增加，且术后阿片类药物需求量增加（不包括术前剂量）（分别为P=0.001和P=0.007）。
术前使用阿片类药物会增加TKA术后静息和行走时疼痛的风险以及阿片类药物消耗量。
