Dwyer C Liam, Soong Maximillian, Hunter Alice, Dashe Jesse, Tolo Eric, Kasparyan N George
Department of Orthopaedic Surgery, Lahey Hospital and Medical Center, Burlington, MA.
Department of Orthopaedic Surgery, Lahey Hospital and Medical Center, Burlington, MA.
J Hand Surg Am. 2018 Jun;43(6):516-522.e1. doi: 10.1016/j.jhsa.2018.01.021. Epub 2018 Mar 12.
We investigated whether written guidelines for surgeons and educational handouts for patients regarding safe and effective opioid use after hand surgery could reduce prescription sizes while achieving high patient satisfaction and a low refill rate.
All patients undergoing isolated carpal tunnel release or distal radius volar locked plating in a hand surgery group practice during a 6-month period were prospectively enrolled. Surgeons prescribed analgesics at their own discretion based on written guidelines. Patients received an educational handout regarding safe opioid use and disposal, a diary to record daily pain visual analog scale score and consumption of opioid and over-the-counter (OTC) analgesics, and a pain catastrophizing scale questionnaire. Collected data were compared with a retrospective cohort of the same surgeons, procedures, and period 1 year earlier.
In the carpal tunnel release group (121 patients), average prescription size was 10 opioid pills, compared with 22 in the prior year. Average consumption was 3 opioid pills, supplemented with 11 OTC pills. In the volar locked plating group (24 patients), average prescription size was 25 opioid pills, compared with 39 in the prior year. Average consumption was 16 opioid pills, supplemented with 20 OTC pills. Patient satisfaction was comparably high in both groups. Eight patients required opioid refills overall. Patients with pain catastrophizing scale greater than 10 used more than twice as many opioid pills. Of 109 patients with leftover opioids, 10 reported proper disposal.
Written guidelines and educational handouts significantly reduced the number of prescribed opioid pills by 35% to 55% while achieving high patient satisfaction and a low refill rate. We recommend 5 to 10 opioid pills for carpal tunnel release and 20 to 30 for distal radius volar plating. Pain catastrophizing is associated with greater opioid consumption and may help target patients for additional support. Potential for opioid abuse and diversion may persist despite these interventions.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
我们研究了针对外科医生的书面指南以及针对患者的关于手部手术后安全有效使用阿片类药物的教育手册，是否能在提高患者满意度和降低再填充率的同时减少处方量。
前瞻性纳入在6个月期间内于手部手术小组诊所接受单纯腕管松解术或桡骨远端掌侧锁定钢板固定术的所有患者。外科医生根据书面指南自行开具镇痛药。患者收到一份关于阿片类药物安全使用和处置的教育手册、一本记录每日疼痛视觉模拟量表评分以及阿片类药物和非处方（OTC）镇痛药使用情况的日记，以及一份疼痛灾难化量表问卷。将收集到的数据与同一组外科医生、相同手术以及1年前同一时期的回顾性队列进行比较。
在腕管松解术组（121例患者）中，平均处方量为10片阿片类药物，而前一年为22片。平均消耗量为3片阿片类药物，辅以11片OTC药物。在掌侧锁定钢板固定术组（24例患者）中，平均处方量为25片阿片类药物，而前一年为39片。平均消耗量为16片阿片类药物，辅以20片OTC药物。两组患者的满意度都相当高。总体有8例患者需要阿片类药物再填充。疼痛灾难化量表得分大于10的患者使用的阿片类药物片数是其他人的两倍多。在109例有剩余阿片类药物的患者中，10例报告进行了妥善处置。
书面指南和教育手册显著减少了35%至55%的阿片类药物处方量，同时实现了高患者满意度和低再填充率。我们建议腕管松解术使用5至10片阿片类药物，桡骨远端掌侧钢板固定术使用20至30片。疼痛灾难化与更多的阿片类药物消耗相关，可能有助于确定需要额外支持的患者。尽管采取了这些干预措施，阿片类药物滥用和转移的可能性可能仍然存在。
研究类型/证据水平：治疗性II级。
