Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri.
J Bone Joint Surg Am. 2018 Oct 3;100(19):1629-1636. doi: 10.2106/JBJS.18.00049.
The opioid epidemic in the United States has placed increased pressure on physicians to engage in responsible opioid prescribing practices. However, surgeons currently have little information to guide their postoperative prescription decision-making. The purpose of this study was to assess opioid consumption after knee arthroscopy and identify preoperative factors that may predict higher opioid usage.
A prospective observational study of 221 patients was conducted in patients undergoing outpatient knee arthroscopy for meniscal repair, partial meniscectomy, debridement, chondroplasty, or loose body removal. Participants recorded their daily opioid consumption in a postoperative pain diary. Total opioid consumption was calculated from counts of remaining pills at the 2-week and 6-week postoperative office visits. Variables, including age, sex, body mass index, smoking status, alcohol consumption, preoperative pain severity and duration, preoperative opioid usage, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and the Connor-Davidson Resilience Scale, were evaluated for an association with opioid consumption.
Total opioid consumption ranged from 0 to 188 pills, with a median of 7 pills (hydrocodone 5-mg equivalents). Forty-six percent of patients took ≤5 pills, 59% took ≤10 pills, and 81% took ≤20 pills. Fifty-six percent of patients had discontinued opioid usage by the third postoperative day. Eighty-eight percent of patients had surplus opioid medication at the time of the final follow-up. Patients undergoing meniscal repair, smokers, and those taking preoperative opioids were significantly more likely to take ≥20 pills (p < 0.05).
The median number of pills taken after knee arthroscopy is 7, with the majority of patients consuming ≤20 pills. Meniscal repair, smoking, and preoperative opioid usage were associated with higher postoperative opioid consumption.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
美国的阿片类药物泛滥给医生带来了更大的压力，要求他们采取负责任的阿片类药物处方实践。然而，外科医生目前几乎没有信息来指导他们术后的处方决策。本研究的目的是评估膝关节镜检查后的阿片类药物消耗，并确定可能预测更高阿片类药物使用的术前因素。
对 221 例接受门诊膝关节镜半月板修复、部分半月板切除术、清创术、软骨成形术或游离体切除术的患者进行前瞻性观察性研究。参与者在术后疼痛日记中记录他们每天的阿片类药物消耗量。根据术后 2 周和 6 周的门诊就诊时剩余药丸的数量计算总阿片类药物消耗量。评估包括年龄、性别、体重指数、吸烟状况、饮酒状况、术前疼痛严重程度和持续时间、术前阿片类药物使用、患者报告的结局测量信息系统（PROMIS）评分和 Connor-Davidson 韧性量表在内的变量与阿片类药物消耗的相关性。
总阿片类药物消耗量从 0 到 188 片不等，中位数为 7 片（氢可酮 5 毫克当量）。46%的患者服用 ≤5 片，59%的患者服用 ≤10 片，81%的患者服用 ≤20 片。56%的患者在术后第 3 天停止使用阿片类药物。88%的患者在最后一次随访时仍有剩余的阿片类药物。半月板修复、吸烟和术前使用阿片类药物的患者更有可能服用 ≥20 片（p < 0.05）。
膝关节镜检查后服用的药丸中位数为 7 片，大多数患者服用 ≤20 片。半月板修复、吸烟和术前阿片类药物使用与术后阿片类药物消耗增加相关。
预后 IV 级。有关证据水平的完整说明，请参阅作者说明。
