Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A..
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
Arthroscopy. 2018 May;34(5):1488-1497.e6. doi: 10.1016/j.arthro.2017.12.005. Epub 2018 Feb 2.
PURPOSE: To provide estimates of postoperative opioid use after hip arthroscopy for femoroacetabular impingement (FAI) syndrome and to identify risk factors for increased postoperative opioid use. METHODS: All patients aged at least 18 years who were undergoing hip arthroscopy for FAI syndrome performed by 1 of 2 hip-preservation surgeons between November 2015 and August 2016 were eligible for inclusion in this study. Target minimum enrollment was set at 30 patients per surgeon based on an a priori sample size calculation. Enrolled patients completed the International Hip Outcome Tool, visual analog pain scale, Pain Catastrophizing Scale, abbreviated Patient Health Questionnaire, and questions regarding demographic characteristics and opioid and anti-inflammatory use. Opioid consumption was assessed through pill counting at 2- and 6-week postoperative appointments. Of 80 patients enrolled, 67 had complete 2- and 6-week opioid use data. Patient and operative factors were correlated with outcomes in multivariate models. RESULTS: Opioid use in the 2 weeks before surgery was significantly associated with higher postoperative opioid use at 2 weeks postoperatively (253.8 additional oral morphine equivalents [OMEs]; 95% confidence interval [CI], 171.2-336.5 additional OMEs; P < .0001; n = 73) and 6 weeks postoperatively (385.3 additional OMEs; 95% CI, 241.6-529.0 additional OMEs; P < .0001; n = 67). By 6 weeks postoperatively, 41 of 52 patients (79%) without opioid use in the 2 weeks before surgery used 30 or fewer 5-mg oxycodone pills compared with only 2 of 15 patients (13%) with preoperative use (odds ratio, 24.9; 95% CI, 4.2-148.5; P < .0001). CONCLUSIONS: Among patients undergoing hip arthroscopy for FAI syndrome, any opioid use in the 2 weeks preceding surgery was the strongest predictor of opioid use after hip arthroscopy. The impact of preoperative opioid use far exceeded the impact of other baseline patient and operative factors. Assessment of preoperative opioid use could be an important factor in guiding postoperative opioid prescribing. LEVEL OF EVIDENCE: Level II, prospective observational study.
目的：提供髋关节镜治疗股骨髋臼撞击综合征（FAI）后术后阿片类药物使用的估计，并确定增加术后阿片类药物使用的风险因素。
方法：所有年龄至少 18 岁的患者均符合纳入标准，他们由 2 位髋关节保护外科医生中的 1 位在 2015 年 11 月至 2016 年 8 月期间进行髋关节镜治疗 FAI 综合征。根据事先的样本量计算，每位外科医生的目标最低入组人数设定为 30 名患者。纳入的患者完成了国际髋关节结果工具、视觉模拟疼痛量表、疼痛灾难化量表、简短患者健康问卷以及关于人口统计学特征、阿片类药物和抗炎药物使用的问题。通过术后 2 周和 6 周的门诊随访时的药片计数来评估阿片类药物的使用情况。在纳入的 80 名患者中，有 67 名患者完成了 2 周和 6 周的完整阿片类药物使用数据。在多变量模型中，患者和手术因素与结果相关。
结果：手术前 2 周内的阿片类药物使用与术后 2 周（253.8 个额外口服吗啡等效物 [OME]；95%置信区间 [CI]，171.2-336.5 个额外 OME；P <.0001；n = 73）和 6 周（385.3 个额外 OME；95%CI，241.6-529.0 个额外 OME；P <.0001；n = 67）时的术后阿片类药物使用显著相关。术后 6 周时，与术前无阿片类药物使用的 52 名患者中的 41 名（79%）相比，仅有术前使用阿片类药物的 15 名患者中的 2 名（13%）使用了 30 片或更少的 5 毫克羟考酮片（比值比，24.9；95%CI，4.2-148.5；P <.0001）。
结论：在接受髋关节镜治疗 FAI 综合征的患者中，手术前 2 周内的任何阿片类药物使用均是髋关节镜治疗后阿片类药物使用的最强预测因素。术前阿片类药物使用的影响远远超过其他基线患者和手术因素的影响。评估术前阿片类药物使用可能是指导术后阿片类药物处方的一个重要因素。
证据等级：II 级，前瞻性观察性研究。
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