Dautremont Erin A, Ebramzadeh Edward, Beck Jennifer J, Bowen Richard E, Sangiorgio Sophia N
The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center (E.A.D., E.E., and S.N.S.), Orthopaedic Institute for Children (J.J.B. and R.E.B.), in alliance with the Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California.
College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada.
JBJS Rev. 2017 Aug;5(8):e5. doi: 10.2106/JBJS.RVW.16.00093.
The proper use of opioid analgesia for postoperative pain management is controversial. While opioids are considered the standard of care for multimodal postoperative pain modulation in the United States, there is a lack of established protocols for prescribing opioids in adolescents undergoing outpatient orthopaedic surgery. The objective of this review was to identify and report on current literature on opioid prescription for pain management in adolescents undergoing all procedures, as well as in adults undergoing outpatient orthopaedic surgery.
A comprehensive literature search using PRISMA guidelines was performed to identify all articles relevant to opioid use in adolescents for postoperative pain and in adults following outpatient orthopaedic procedures.
A total of 4,446 results were identified from databases and relevant journal web sites. Of these, 9 articles were selected that fit the criteria for review. Five studies discussed the dosage and type of opioids prescribed in adolescent populations, and 4 quantified patient self-administration in adult populations.
Adolescent opioid pain management following outpatient orthopaedic surgery is not documented. Current recommendations for opioid prescription in adolescents lack support and are primarily based on adult dosages. Adult studies suggest that opioid medications may be overprescribed following outpatient orthopaedic surgery. These results clearly indicate that there is a pressing need for quantitative research on pain management following outpatient orthopaedic surgery in the adolescent population in the United States.
There appear to be no studies on self-administered opioid pain medication following orthopaedic surgery in an adolescent population, suggesting that there is no objective basis for the current prescription recommendations.
阿片类药物用于术后疼痛管理的合理应用存在争议。在美国，虽然阿片类药物被视为多模式术后疼痛调节的护理标准，但对于接受门诊骨科手术的青少年，缺乏既定的阿片类药物处方方案。本综述的目的是识别并报告当前关于所有手术的青少年以及接受门诊骨科手术的成年人疼痛管理的阿片类药物处方的文献。
采用PRISMA指南进行全面的文献检索，以识别所有与青少年术后疼痛使用阿片类药物以及门诊骨科手术后成年人使用阿片类药物相关的文章。
从数据库和相关期刊网站共识别出4446条结果。其中，9篇文章符合综述标准被选中。5项研究讨论了青少年人群中阿片类药物的处方剂量和类型，4项研究对成年人群中的患者自我给药进行了量化。
门诊骨科手术后青少年阿片类药物疼痛管理尚无文献记载。目前青少年阿片类药物处方建议缺乏依据，主要基于成人剂量。成人研究表明，门诊骨科手术后阿片类药物可能存在过度处方的情况。这些结果清楚地表明，美国青少年人群门诊骨科手术后疼痛管理的定量研究迫在眉睫。
似乎没有关于青少年骨科手术后自我给药阿片类止痛药物的研究，这表明当前的处方建议没有客观依据。
