Sabesan Vani J, Petersen-Fitts Graysen R, Sweet Matthew C, Katz Danielle L, Lima Diego J L, Whaley James D
Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Department of Orthopaedic Surgery, Beaumont Health, Taylor, MI, USA.
JSES Open Access. 2018 Jun 21;2(3):155-158. doi: 10.1016/j.jses.2018.05.001. eCollection 2018 Oct.
Preoperative opioid use has been correlated to suboptimal outcomes in orthopedic surgery. This study evaluated the effect of preoperative opioid use on outcomes after arthroscopic rotator cuff repair (RCR).
A retrospective review was performed of 79 patients who underwent arthroscopic RCR; of these, 31 with a history of preoperative opioid use were compared with a control group of 48 patients without a history of preoperative opioid use. Preoperative and postoperative patient-reported outcomes and functional scores were compared.
Both cohorts significantly improved on all patient-reported shoulder scores; however, the nonopioid group demonstrated significantly better postoperative patient-reported outcome scores ( = .015) and external rotation measurement ( = .008). Functional outcomes also significantly improved from preoperatively to postoperatively for forward flexion, but no differences were seen between groups.
Patients with a history of preoperative opioid use can still achieve significant improvements in outcomes after arthroscopic RCR, although not to the same extent as opioid-naïve patients. Therefore, orthopedic surgeons must consider a patient's preoperative opioid use and temper expectations with regard to outcomes so that they are able to set realistic postoperative goals for patients undergoing RCR.
术前使用阿片类药物与骨科手术的不良预后相关。本研究评估了术前使用阿片类药物对关节镜下肩袖修复术（RCR）后预后的影响。
对79例行关节镜下RCR的患者进行回顾性研究；其中，将31例有术前使用阿片类药物史的患者与48例无术前使用阿片类药物史的对照组患者进行比较。比较术前和术后患者报告的预后及功能评分。
两组患者所有患者报告的肩部评分均显著改善；然而，未使用阿片类药物组术后患者报告的预后评分（P = 0.015）和外旋测量值（P = 0.008）明显更好。前屈功能预后从术前到术后也显著改善，但两组之间未见差异。
有术前使用阿片类药物史的患者在关节镜下RCR术后仍能实现预后的显著改善，尽管程度不如未使用阿片类药物的患者。因此，骨科医生必须考虑患者术前使用阿片类药物的情况，并调整对预后的期望，以便能够为接受RCR的患者设定现实的术后目标。
