Rodriguez-Buitrago Andres, Attum Basem, Enata Nichelle, Evans Adam, Obremskey William, Sethi Manish, Jahangir Alex
Orthopedic Trauma Service, Department of Orthopedics, Vanderbilt Medical Center, 1215 21st Avenue South, Suite 4200 MCE-South Tower Nashville, TN, 37232, USA.
Meharry Medical College, 1005 Dr. D.B. Todd Jr, Blvd, Nashville, TN, 37208.
J Foot Ankle Surg. 2018 Nov-Dec;57(6):1167-1171. doi: 10.1053/j.jfas.2018.06.010.
The purpose of our study was to identify the opioid-prescribing practices after operative treatment of isolated pilon fractures at a level 1 trauma center. Patients ≥ 18 years of age with an operatively treated isolated pilon fracture between 2005 and 2015 were identified. Total morphine milligram equivalents (MMEs) were then calculated. Mean and standard deviations were calculated for patients without a history of opiate use and for patients with a history of opiate use within 1 year prior to injury. Data were obtained from the State Controlled Substance Monitoring Database. Seventy-two patients met our inclusion criteria; of these, 54% (39/72) were opiate exposed at the time of injury. Median MMEs prescribed were 2738 (range 375 to 12,360). Orthopedic providers prescribed 61% of all the MMEs (median 2010; range 113 to 6825), while nonorthopedic providers prescribed a median of 338 MMEs (range 0 to 10,080) (p < .05). Combined, patients with exposure 1 year before the injury received more MMEs (median 3600; range 840 to 12,360) than opiate-naive patients (median 2520; range 375 to 10,610) (p < .05). Twenty-eight (38.9%) patients continued using opiates for more than 6 months after their injury; 25% (7/28) were not previously exposed. There is great variability regarding the quantity of opiates being prescribed after isolated pilon fractures, and 39% of opiate prescriptions are coming from nonorthopedic prescribers. Opiate-exposed patients are more likely to be prescribed more opiates by orthopedists and outside physicians and for a longer duration. We believe that adequate pain control can be obtained by prescribing 40 pills of oxycodone 10 mg with a maximum of 1 additional refill. In cases in which a staged procedure is planned, an additional refill is expected (total of 3 refills).
我们研究的目的是确定在一级创伤中心对单纯性Pilon骨折进行手术治疗后的阿片类药物处方情况。确定了2005年至2015年间年龄≥18岁且接受手术治疗的单纯性Pilon骨折患者。然后计算吗啡毫克当量（MME）总量。计算了无阿片类药物使用史患者以及受伤前1年内有阿片类药物使用史患者的均值和标准差。数据来自国家管制物质监测数据库。72名患者符合我们的纳入标准；其中，54%（39/72）在受伤时暴露于阿片类药物。处方MME的中位数为2738（范围375至12360）。骨科医生开具了所有MME的61%（中位数2010；范围113至6825），而非骨科医生开具的MME中位数为338（范围0至10080）（p<0.05）。综合来看，受伤前1年暴露于阿片类药物的患者比未使用过阿片类药物的患者接受了更多的MME（中位数3600；范围840至12360）（p<0.05）。28名（38.9%）患者受伤后继续使用阿片类药物超过6个月；25%（7/28）此前未暴露于阿片类药物。单纯性Pilon骨折后开具的阿片类药物数量差异很大，39%的阿片类药物处方来自非骨科开方者。暴露于阿片类药物的患者更有可能被骨科医生和外部医生开具更多的阿片类药物，且用药时间更长。我们认为，开具40片10毫克羟考酮，最多额外再开一次药，就能实现充分的疼痛控制。在计划进行分期手术的情况下，预计会额外再开一次药（总共3次开药）。
