From the Department of Orthopedic Surgery, Keck Medicine of University of Southern California, Los Angeles, CA.
J Am Acad Orthop Surg. 2019 Aug 15;27(16):e734-e742. doi: 10.5435/JAAOS-D-18-00112.
Preoperative opioid use has recently been associated with increased perioperative pain. This study evaluates the effect of preoperative opioid use on postoperative pain and duration of opioid use after total shoulder arthroplasty (TSA).
We retrospectively identified 138 TSAs (69.1% reverse and 30.9% anatomic) between January 2013 and April 2017 that met inclusion criteria. Patients were stratified into two groups based on opioid usage within the 4 weeks before surgery. Primary outcome was resting pain at 3 months postoperatively using a 10-point numerical rating scale system. Duration of postoperative opioid consumption was also recorded and compared between cohorts.
The opioid cohort (n = 50) reported significantly greater resting pain and pain with activity at 3 months postoperatively, at which time the reported numerical rating scale pain scores were 1.6 and 2.8 points greater in the opioid cohort compared with the non-opioid cohort (P < 0.001). Preoperative opioid use strongly predicted postoperative opioid use at all follow-up time points (P < 0.0001).
Preoperative opioid consumption is associated with higher pain and increased duration of opioid use after TSA.
最近研究表明，术前使用阿片类药物与围手术期疼痛增加有关。本研究评估了术前使用阿片类药物对全肩关节置换术后（TSA）疼痛和阿片类药物使用时间的影响。
我们回顾性地确定了 2013 年 1 月至 2017 年 4 月期间符合纳入标准的 138 例 TSA（69.1%为反向和 30.9%为解剖型）。根据手术前 4 周内是否使用阿片类药物，将患者分为两组。主要结果是术后 3 个月时使用 10 分数字评分系统评估静息疼痛。并比较两组患者术后阿片类药物使用的持续时间。
使用阿片类药物的患者（n = 50）在术后 3 个月时报告的静息疼痛和活动时疼痛明显更严重，此时阿片类药物组报告的数字评分量表疼痛评分比非阿片类药物组高 1.6 和 2.8 分（P < 0.001）。术前使用阿片类药物强烈预测术后所有随访时间点的阿片类药物使用（P < 0.0001）。
术前阿片类药物的使用与 TSA 后疼痛加重和阿片类药物使用时间延长有关。
