Division of Orthopaedic Trauma, Department of Orthopedics, Vanderbilt Medical Center, Nashville, TN.
Meharry Medical College, Nashville, TN.
J Orthop Trauma. 2018 Mar;32(3):e106-e111. doi: 10.1097/BOT.0000000000001046.
The purpose of this retrospective study was to identify opioid prescribing practices, determine the number of morphine milliequivalents (MMEs) prescribed by orthopaedic/nonorthopaedic members to narcotic naive and previously exposed patients, and provide narcotic prescribing recommendations.
Patients older than 18 years with an isolated femur fracture sustained between 2013 and 2015 were identified using the CPT code 27506. Prescribing information was obtained from the State Controlled Substance Monitoring Database. Descriptive analysis of MMEs was then performed. Outliers and patients without prescriptions from orthopaedic providers were excluded to eliminate skewing of data. Mean and standard deviations were then calculated for patients without a history of opiates prescribed within 1 year of injury and for patients with a history of opiates prescribed within 1 year before the injury.
Forty-five percent (40/88) of patients were opiate exposed at the time of injury. Previously exposed patients received 1491 MMEs (SD, 1044; median, 1350; range, 210-5140) and nonexposed patients received 1363 MMEs (SD, 977.2; median, 1260; range, 105-4935) from orthopaedic providers (P = 0.1473). Nonorthopedists prescribed 530 MMEs (SD, 780.7; median, 140; range, 0-3515) to previously exposed patients and 175 MMEs (SD, 393; median, 140; range, 0-1890) to patients without exposure (P < 0.0001).
Patients with prior exposure are more likely to be prescribed more opiates after femoral shaft fracture treatment. We recommend a protocol of prescribing half the mean of MMEs currently prescribed by orthopedists equating to 47 (711 MMEs) pills of oxycodone 10 mg in up to 3 prescriptions.
本回顾性研究旨在确定骨科/非骨科医生为初次使用阿片类药物和以前使用过阿片类药物的患者开具的阿片类药物处方实践，确定开给初次使用阿片类药物的患者的美沙酮毫克当量（MME）数量，并提供阿片类药物处方建议。
使用 CPT 代码 27506 确定 2013 年至 2015 年间发生的单纯股骨干骨折的 18 岁以上患者。从国家管制物质监测数据库中获取处方信息。然后对 MME 进行描述性分析。排除骨科医生未开处方的离群值和患者，以消除数据偏斜。对于无 1 年内受伤前开阿片类药物史的患者和有 1 年内受伤前开阿片类药物史的患者，计算 MME 的平均值和标准差。
45%（40/88）的患者在受伤时曾使用过阿片类药物。以前暴露于阿片类药物的患者从骨科医生那里获得了 1491 MME（SD，1044；中位数，1350；范围，210-5140），未暴露于阿片类药物的患者获得了 1363 MME（SD，977.2；中位数，1260；范围，105-4935）（P = 0.1473）。非骨科医生为以前暴露于阿片类药物的患者开具了 530 MME（SD，780.7；中位数，140；范围，0-3515），为无暴露史的患者开具了 175 MME（SD，393；中位数，140；范围，0-1890）（P < 0.0001）。
股骨干骨折治疗后，以前暴露于阿片类药物的患者更有可能被开具更多的阿片类药物。我们建议制定一个处方方案，即开具骨科医生目前开具的 MME 平均值的一半，相当于开具 47 片（10mg 羟考酮 711 MME）的羟考酮，最多开具 3 张处方。
