Raney Ellen M, van Bosse Harold J P, Shea Kevin G, Abzug Joshua M, Schwend Richard M
Shriners Hospitals for Children, Portland, OR.
Shriners Hospitals for Children, Philadelphia, PA.
J Pediatr Orthop. 2018 May/Jun;38(5):e238-e244. doi: 10.1097/BPO.0000000000001143.
The opioid epidemic in the United States has reached crisis proportions. Urgent response is needed. Hydrocodone in combination with acetaminophen is the most prescribed drug in the United States. The most common source of opioids available for misuse is the unused portions of postoperative prescriptions. Among high school seniors, 80% of those who reported nonmedical use of prescription opioids previously had legitimate prescriptions but recreationally used leftover doses. Roughly one-quarter of patients do not take any of their postoperatively prescribed opioids and the remainder take one-third to two-thirds of the prescribed doses.
A summary of the literature is presented beginning from historical perspective to current status and pertinent strategies in dealing with this complicated problem. This review includes data from an electronic survey of the members of the Pediatric Orthopaedic Society of North America (POSNA) with regard to the prescriptions they would provide for 7 treatment scenarios.
Strategies for the preoperative, intraoperative, and postoperative phases of management of pain as well as strategies for education, research, and advocacy are presented. The Pediatric Orthopaedic Society of North America survey yielded 264 respondents. The 3 most commonly used opioid medications were hydrocodone, oxycodone, and acetaminophen with codeine, in that order, for most of the scenarios. The time period covered by postoperative prescriptions varied considerably.
The magnitude of this problem is overwhelming. Education of care providers, patients and families, standardization of narcotic prescribing practices which incorporate patient characteristics, and appropriate plans for disposal of unused narcotics are immediate concepts to consider in correcting this problem. Long-term issues to tackle will be changing patient a family expectations, legislation, and obtaining additional resources directed towards this issue.
美国的阿片类药物泛滥已达到危机程度，急需做出紧急应对。氢可酮与对乙酰氨基酚的复方制剂是美国处方量最大的药物。可被滥用的阿片类药物最常见的来源是术后未使用完的处方部分。在高中高年级学生中，80%报告曾非医疗使用处方阿片类药物的人之前有合法处方，但将剩余剂量用于消遣。大约四分之一的患者术后未服用任何处方阿片类药物，其余患者服用了规定剂量的三分之一至三分之二。
本文从历史角度到当前状况以及处理这一复杂问题的相关策略对文献进行了综述。本综述纳入了对北美小儿骨科学会（POSNA）成员进行电子调查的数据，内容涉及他们针对7种治疗场景开具的处方。
介绍了疼痛管理术前、术中和术后阶段的策略以及教育、研究和宣传策略。北美小儿骨科学会的调查有264名受访者。在大多数场景中，最常用的3种阿片类药物依次为氢可酮、羟考酮和对乙酰氨基酚可待因复方制剂。术后处方涵盖的时间段差异很大。
这个问题的严重程度令人难以承受。对医护人员、患者及其家属进行教育，使麻醉处方做法标准化并纳入患者特征，以及制定妥善处理未使用麻醉药品的计划，是纠正这一问题时应立即考虑的事项。长期需要解决的问题将是改变患者和家属的期望、立法，并获取针对此问题的更多资源。
