Grant Daniel R, Schoenleber Scott J, McCarthy Alicia M, Neiss Geraldine I, Yorgova Petya K, Rogers Kenneth J, Gabos Peter G, Shah Suken A
Department of Orthopaedics, West Virginia University, Morgantown, West Virginia
Department of Orthopaedic Surgery, Nicklaus Children's Hospital, Miami, Florida.
J Bone Joint Surg Am. 2016 Sep 21;98(18):1555-62. doi: 10.2106/JBJS.16.00101.
Physicians play a role in the current prescription drug-abuse epidemic. Surgeons often prescribe more postoperative narcotic pain medication than patients routinely need. Although narcotics are effective for severe, acute, postoperative pain, few evidence-based guidelines exist regarding the routinely required amount and duration of use post-hospital discharge.
Patients in a prospective cohort undergoing posterior spinal fusion for idiopathic scoliosis were asked preoperatively to rate their pain level, the level of pain expected each week postoperatively, and their pain tolerance. Post-discharge pain scores and narcotic use were reported at weekly intervals for 4 weeks postoperatively. Demographic data, preoperative Scoliosis Research Society (SRS)-22 scores, operative details, perioperative data, and self-reported pain levels were analyzed with respect to their association with total medication use and refills received. Disposal plans were also assessed.
Seventy-two patients were enrolled, and 85% completed the surveys. The mean patient age was 14.9 years; 69% of the patients were female. The cohort was divided into 3 groups on the basis of total medication usage. The mean number of pills used in the middle (average-use) group was 49 pills. In postoperative week 4, narcotic usage was minimal (a mean of 2.9 pills by the highest-use group). Also by this time point, pain scores had, on average, returned to preoperative levels. Older age, male sex, a higher body mass index, and a higher preoperative pain score were associated with increased narcotic use. Sixty-seven percent of the patients planned to dispose of their unused medication, although only 59% of those patients planned on doing so in a manner recommended by the U.S. Food and Drug Administration.
Postoperative narcotic dosing may be improved by considering patient age, weight, sex, and preoperative pain score. The precise estimation of individual narcotic needs is complex. Patient and family education on the importance and proper method of narcotic disposal is an essential component of minimizing the availability of unused postoperative medication.
Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
医生在当前的处方药滥用流行中发挥着作用。外科医生通常开出的术后麻醉性止痛药比患者常规所需的更多。尽管麻醉药对严重的急性术后疼痛有效，但关于出院后常规所需的用量和使用时长，几乎没有基于证据的指南。
对因特发性脊柱侧凸接受后路脊柱融合术的前瞻性队列患者，在术前询问其疼痛水平、术后每周预期的疼痛水平以及疼痛耐受性。术后4周每周报告出院后的疼痛评分和麻醉药使用情况。分析人口统计学数据、术前脊柱侧凸研究学会（SRS）-22评分、手术细节、围手术期数据以及自我报告的疼痛水平与总用药量和续方的相关性。还评估了处理计划。
纳入72例患者，85%完成了调查。患者平均年龄为14.9岁；69%为女性。根据总用药量将队列分为3组。中间（平均用药）组的平均用药片数为49片。在术后第4周，麻醉药使用量极少（最高用药组平均为2.9片）。到这个时间点，疼痛评分平均已恢复到术前水平。年龄较大、男性、较高的体重指数和较高的术前疼痛评分与麻醉药使用增加有关。67%的患者计划处理未使用的药物，尽管这些患者中只有59%计划以美国食品药品监督管理局推荐的方式处理。
考虑患者的年龄、体重、性别和术前疼痛评分可能会改善术后麻醉药的给药。精确估计个体对麻醉药的需求很复杂。对患者及其家属进行关于麻醉药处理的重要性和正确方法的教育，是减少未使用的术后药物可获得性的重要组成部分。
预后I级。有关证据水平的完整描述，请参阅作者指南。
