骨科手术后处方类阿片类型与延长类阿片使用可能性的关系。
Prescription Opioid Type and the Likelihood of Prolonged Opioid Use After Orthopaedic Surgery.
机构信息
From the Department of Economics (Mr. Basilico), Harvard University and Harvard Medical School, the Harvard Combined Orthopaedics Residency Program (Dr. Bhashyam), the Department of Orthopaedic Surgery (Dr. Harris), Massachusetts General Hospital, Harvard Orthopaedic Trauma Initiative, Harvard Medical School, and the Department of Orthopaedics (Dr. Heng), Massachusetts General Hospital, Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Cambridge, MA.
出版信息
J Am Acad Orthop Surg. 2019 May 1;27(9):e423-e429. doi: 10.5435/JAAOS-D-17-00663.
INTRODUCTION
A common belief is that some narcotic medications have a higher association with prolonged use. We assessed whether the initial opiate type prescribed to postoperative, opiate-naive orthopaedic trauma patients was associated with prolonged opioid use.
METHODS
We studied 17,961 adult, opiate-naive patients treated for a surgical musculoskeletal injury. Discharge prescription in morphine milligram equivalents (MMEs, a standardized dosing unit that allows for comparison across opioid types) was calculated. Opioid prescribing beyond 90 days after injury was defined as prolonged use.
RESULTS
Initial analysis demonstrated a higher likelihood of prolonged use for patients discharged on hydromorphone or morphine versus hydrocodone. However, when we adjusted for discharge MME, only opioid quantity was predictive of prolonged use (P < 0.001). In addition, discharge MME was associated with opioid type (P < 0.01).
DISCUSSION
Persistent opiate use was associated with discharge opioid quantity, not the opioid type. These results highlight the importance of calculating equivalence doses when selecting opioid types and considering amount of narcotics prescribed.
LEVEL OF EVIDENCE
Level III.
简介
人们普遍认为，某些类阿片药物与长期使用的关联性更高。我们评估了术后初次使用阿片类药物且无阿片类药物使用史的骨科创伤患者所使用的初始阿片类药物类型是否与延长阿片类药物使用时间有关。
方法
我们研究了 17961 名接受手术治疗的、无阿片类药物使用史的成年骨骼肌肉损伤患者。通过计算吗啡毫克当量（MME，一种标准化的剂量单位，可用于比较不同类型的阿片类药物）来计算出院时的处方。将损伤后 90 天以上的阿片类药物处方定义为延长使用。
结果
初步分析表明，与使用氢吗啡酮或吗啡相比，使用氢可酮的患者延长使用的可能性更高。然而，当我们根据出院时的 MME 进行调整时，只有阿片类药物的数量与延长使用有关（P < 0.001）。此外，出院时的 MME 与阿片类药物类型有关（P < 0.01）。
讨论
持续使用阿片类药物与出院时的阿片类药物剂量有关，而与阿片类药物类型无关。这些结果强调了在选择阿片类药物类型和考虑开具的麻醉性镇痛药数量时计算等效剂量的重要性。
证据等级
III 级。
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