Duke University, Division of Emergency Medicine, Durham, North Carolina.
Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center, Denver, Colorado.
West J Emerg Med. 2019 May;20(3):497-505. doi: 10.5811/westjem.2019.3.42693. Epub 2019 Apr 26.
Copperhead envenomation causes local tissue destruction, leading people to seek treatment for the pain and swelling. First-line treatment for the pain is opioid medications. There is rising concern that an initial opioid prescription from the emergency department (ED) can lead to long-term addiction. This analysis sought to determine whether use of Fab antivenom (FabAV) for copperhead envenomation affected opioid use.
We performed a secondary analysis using data from a randomized clinical trial designed to determine the effect of FabAV on limb injury recovery following mild to moderate copperhead envenomation. Opioid use was a defined secondary outcome in the parent trial. Patients were contacted after discharge, and data were obtained regarding medications used for pain and the patients' functional status. This analysis describes the proportion of patients in each treatment group reporting opioid use at each time point. It also assesses the interaction between functional status and use of opioids.
We enrolled 74 patients in the parent trial (45 received FabAV, 29 placebo), of whom 72 were included in this secondary analysis. Thirty-five reported use of any opioids after hospital discharge. A smaller proportion of patients treated with FabAV reported opioid use: 40.9% vs 60.7% of those in the placebo group. The proportion of patients using opioids remained smaller in the FabAV group at each follow-up time point. Controlling for confounders and interactions between variables, the model estimated that the odds ratio of using opioids after hospital discharge among those who received placebo was 5.67 times that of those who received FabAV. Patients who reported higher baseline pain, those with moderate as opposed to mild envenomation, and females were more likely to report opioid use at follow-up. Patients with ongoing limitations to functional status had an increased probability of opioid use, with a stronger association over time. Opioid use corresponded with the trial's predefined criteria for full recovery, with only two patients reporting opioid use in the 24 hours prior to achieving full limb recovery and no patients in either group reporting opioid use after full limb recovery.
In this study population, the proportion of patients using opioids for pain related to envenomation was smaller in the FabAV treatment group at all follow-up time points.
响尾蛇咬伤会导致局部组织破坏，促使人们因疼痛和肿胀寻求治疗。疼痛的一线治疗药物是阿片类药物。人们越来越担心急诊室（ED）开出的初始阿片类药物处方可能导致长期成瘾。这项分析旨在确定抗响尾蛇蛇毒血清（FabAV）治疗响尾蛇咬伤是否会影响阿片类药物的使用。
我们使用一项旨在确定 FabAV 对轻度至中度响尾蛇咬伤后肢体损伤恢复影响的随机临床试验的数据进行了二次分析。在该试验中，阿片类药物的使用是一个已定义的次要结局。患者在出院后被联系，并获得有关用于缓解疼痛的药物和患者功能状态的数据。本分析描述了每组患者在每个时间点报告使用阿片类药物的比例。它还评估了功能状态与阿片类药物使用之间的相互作用。
我们在主要试验中招募了 74 名患者（45 名接受 FabAV 治疗，29 名接受安慰剂治疗），其中 72 名患者被纳入本二次分析。35 名患者在出院后报告使用任何阿片类药物。接受 FabAV 治疗的患者中报告使用阿片类药物的比例较小：接受安慰剂治疗的患者中有 40.9%，而接受 FabAV 治疗的患者中有 60.7%。在每个随访时间点，接受 FabAV 治疗的患者中使用阿片类药物的比例仍然较小。控制混杂因素和变量之间的相互作用后，模型估计接受安慰剂的患者出院后使用阿片类药物的几率是接受 FabAV 治疗的患者的 5.67 倍。报告基线疼痛较高、中度咬伤而非轻度咬伤以及女性的患者在随访时更有可能报告使用阿片类药物。功能状态持续受限的患者使用阿片类药物的可能性增加，且随着时间的推移关联更强。阿片类药物的使用与试验的完全恢复的预定义标准相对应，只有两名患者在达到完全肢体恢复的前 24 小时内报告使用阿片类药物，且两组患者在完全肢体恢复后均未报告使用阿片类药物。
在本研究人群中，在所有随访时间点，接受 FabAV 治疗的患者因蛇咬伤相关疼痛而使用阿片类药物的比例较小。
