Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York, U.S.A.
Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York, U.S.A..
Arthroscopy. 2019 Mar;35(3):864-870.e1. doi: 10.1016/j.arthro.2018.09.018. Epub 2019 Feb 4.
To evaluate the efficacy of oral nonsteroidal anti-inflammatory drugs (NSAIDs) as the primary postoperative pain medication compared with standard oral opioids following arthroscopic partial meniscectomy.
This was a single-center, prospective, nonrandomized, comparative observational study. Patients ages 18 to 65 years who were indicated for arthroscopic meniscectomy were included. Postoperatively, patients were prescribed 1 of 2 analgesic regimens: (1) ibuprofen (600 mg every 6-8 hours as needed) and 10 tablets of oxycodone/acetaminophen (5/325 mg as needed for breakthrough pain) or (2) 30 to 40 tablets oxycodone/acetaminophen (5/325 mg every 6 hours as needed). Subjects completed questionnaires at 8 hours, 24 hours, 48 hours, and 1 week after surgery, which included medication usage, visual analog scale pain score, incidence of adverse events, and patient satisfaction.
Sixty-eight patients with mean age 51.2 years (±10.4 years) were enrolled between October 2016 and February 2017. Enrollment in the opioid group continued until 30 patients were enrolled in the NSAID group, and at final analysis there were 28 patients in the NSAID group and 40 in the opioid group. There were no significant differences in sex, visual analog scale pain score, or patient satisfaction between the 2 groups at any time point. Patients in the opioid group had a significantly higher mean opioid consumption on postoperative day 1 (1.1 vs 0.5 tablets, P < .03) and postoperative days 3 to 7 (2.6 vs 0.5 tablets, P < .02) compared with NSAID group patients. There was a trend toward greater total (1 week) opioid usage (4.7 vs 2.0 tablets) in the opioid group; however, this was not statistically significant (P < .08). Fifty-three percent of opioid group patients independently chose to forego their opioid medication for an over-the-counter NSAID and/or acetaminophen instead. No patients requested a medication refill.
We found no significant difference in pain control, satisfaction, and total 1-week opioid use between patients prescribed NSAIDs with opioids and those prescribed opioids alone. All patients used only limited amounts of opioids to control postoperative pain, suggesting we are currently overprescribing opioids after arthroscopic partial meniscectomy.
Level II, prospective comparative study.
评估与标准口服阿片类药物相比，口服非甾体抗炎药（NSAIDs）作为关节镜部分半月板切除术术后主要止痛药物的疗效。
这是一项单中心、前瞻性、非随机、对照观察性研究。纳入年龄在 18 至 65 岁之间、拟行关节镜半月板切除术的患者。术后，患者接受以下 2 种镇痛方案之一的治疗：（1）布洛芬（600mg，按需每 6-8 小时 1 次）和 10 片羟考酮/对乙酰氨基酚（5/325mg，按需用于爆发性疼痛）或（2）30 至 40 片羟考酮/对乙酰氨基酚（5/325mg，按需每 6 小时 1 次）。术后 8 小时、24 小时、48 小时和 1 周时，患者完成问卷，内容包括用药情况、视觉模拟评分疼痛评分、不良事件发生率和患者满意度。
2016 年 10 月至 2017 年 2 月期间共纳入 68 例平均年龄 51.2 岁（±10.4 岁）的患者。阿片类药物组持续入组至 30 例，然后开始入组 NSAIDs 组，最终 NSAIDs 组入组 28 例，阿片类药物组入组 40 例。两组在任何时间点的性别、视觉模拟评分疼痛评分或患者满意度均无显著差异。阿片类药物组术后第 1 天（1.1 片 vs 0.5 片，P <.03）和术后第 3 至 7 天（2.6 片 vs 0.5 片，P <.02）的平均阿片类药物消耗量明显更高。阿片类药物组的总（1 周）阿片类药物使用量有增加趋势（4.7 片 vs 2.0 片）；然而，差异无统计学意义（P <.08）。53%的阿片类药物组患者自行选择放弃阿片类药物，改用非处方 NSAIDs 和/或对乙酰氨基酚。没有患者要求药物续方。
我们发现，接受 NSAIDs 联合阿片类药物治疗与单独接受阿片类药物治疗的患者在疼痛控制、满意度和 1 周内总阿片类药物使用方面均无显著差异。所有患者仅使用有限剂量的阿片类药物来控制术后疼痛，表明我们目前在关节镜部分半月板切除术后阿片类药物的处方过量。
II 级，前瞻性比较研究。
