Vanderbilt Medical Center, Nashville, TN.
Meharry Medical College, Nashville, TN.
J Orthop Trauma. 2019 Mar;33(3):e93-e99. doi: 10.1097/BOT.0000000000001375.
This retrospective study aimed at identifying opiate prescribing practices, the number of morphine milligram equivalents (MMEs) prescribed by orthopaedic and nonorthopaedic providers in patients with operatively treated isolated lower extremity fractures, and provide opiate prescribing recommendations.
Patients older than 18 years with isolated lower extremity (unicondylar, bicondylar, tibial shaft, pilon, and ankle) fractures between 2005 and 2016 were identified. Prescribing information was obtained from the State Controlled Substance Monitoring Database. Descriptive statistics were calculated for each injury and plotted for MME use. Mann-Whitney and Wilcoxon tests were used for data analysis. To aid in clinical relevance, MMEs were converted to number of pills of oxycodone 10 mg (OC 10 mg).
Three hundred forty-one patients met our inclusion criteria. Mean age was 45 years; 56% (192/341) were men. Forty-seven percent (159/341) were prescribed opiates before their injury. Orthopaedic providers prescribed more opiates to patients with pilon fractures compared with unicondylar (P = 0.010), tibial shaft (P < 0.001), and ankle (P < 0.001) fractures. Bicondylar plateau fracture patients also received more opiates when compared with unicondylar (P = 0.001), tibial shaft (P < 0.001), and ankle (P < 0.001) fractures. Nonorthopaedic providers prescribed more opiates to patients with pilon fractures when compared with unicondylar (P = 0.006), bicondylar (P < 0.001), tibial shaft (P < 0.001), and ankle fractures (P = 0.006). Differences between orthopaedic and nonorthopaedic MMEs prescribed are significantly different for each injury type (<0.05).
Patients with pilon or bicondylar tibial plateau fractures are currently being prescribed more opiates when compared with other isolated fractures. We have developed an opiate prescription guideline based on what is being prescribed by orthopaedic providers.
本回顾性研究旨在确定接受手术治疗的下肢孤立性骨折患者的骨科和非骨科医生开具的阿片类药物处方情况、开具的美沙酮毫克当量（MME）数量，并提供阿片类药物处方建议。
确定了 2005 年至 2016 年间患有下肢孤立性（单髁、双髁、胫骨骨干、pilon 和踝关节）骨折的年龄大于 18 岁的患者。从国家管制物质监测数据库中获取处方信息。对每个损伤进行描述性统计，并绘制 MME 使用情况图。 Mann-Whitney 和 Wilcoxon 检验用于数据分析。为了便于临床参考，将 MME 转换为奥施康定 10mg 片数（OC 10mg）。
341 名患者符合纳入标准。平均年龄为 45 岁；56%（192/341）为男性。47%（159/341）在受伤前服用过阿片类药物。与单髁、胫骨骨干和踝关节骨折相比，骨科医生为 pilon 骨折患者开具的阿片类药物更多（P=0.010）。双髁平台骨折患者与单髁（P=0.001）、胫骨骨干（P<0.001）和踝关节（P<0.001）骨折患者相比，也接受了更多的阿片类药物。与单髁、双髁、胫骨骨干和踝关节骨折相比，非骨科医生为 pilon 骨折患者开具的阿片类药物更多（P=0.006）。每种损伤类型的骨科和非骨科医生开具的 MME 之间的差异均有统计学意义（<0.05）。
与其他孤立性骨折相比，pilon 或双髁胫骨平台骨折患者目前开具的阿片类药物更多。我们根据骨科医生开具的处方制定了阿片类药物处方指南。
