Anesthesiology Department, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Anesthesiology University of Wisconsin, School of Medicine and Public Health, Madison, WI.
Pain Physician. 2020 Jan;23(1):73-85.
Opioid prescription before knee replacement surgery is associated with longer hospital stays, more postsurgical pain, and a higher rate of complications. Despite the growing evidence against opioids, they remain popular preoperative pain management prescriptions.
The purpose of this study was to examine the effects of dosage of preoperative opioid use on orthopedic knee surgery pain control and postoperative outcomes and complications.
Observational, retrospective evaluation.
University of Wisconsin Madison hospitals.
The patients underwent orthopedic knee surgery between May 1, 2014 and April 30, 2015. We randomly selected 197 patients and divided them into 2 groups that had preoperative opioid dosages of either low dose <= 120 mEq morphine (MME) or high dose >120 MME. Of 197 patients, 100 were in the low dose morphine group, whereas 97 were high dose. The cutoff at 120 MME was calculated to be the median dosage across all patients. The primary outcomes were compared, differences in postoperative pain control, and range of motion (ROM). Secondary outcomes included anesthetic complications, length of hospital stay, postoperative opioid dose, and postoperative complications.
There were no statistically significant differences between the groups with regard to postoperative pain control, ROM, and immediate postoperative complications. Both groups showed similar length of hospitalization (2.199 to 2.304 days; P = 0.374), rate of postoperative infection, and joint intervention. The high dose group was more likely to have postoperative hemarthrosis and emergency department (ED) visits. However, the low dose group was more likely to have hypertension concurrently.
Because the study length was restricted to one year, the lack of data on longer term prognosis may limit extrapolation of data. Subjectivity of pain is difficult to measure and compare objectively. This study was not randomized prospectively, which may bias certain results due to unobserved differences.
Preoperative opioid dose did not affect postoperative pain control or ROM in patients who received knee surgeries. Higher preoperative opioid doses were associated with more hemarthrosis and ED visits. Further exploration into quality of life indices and surgical complications such as need for revision may be a fruitful avenue.
Opioids, analgesic, knee pain, total knee replacement, knee surgery, pre-operative opioids, knee outcomes.
膝关节置换术前开具阿片类药物与住院时间延长、术后疼痛加重和并发症发生率升高有关。尽管越来越多的证据表明阿片类药物的使用存在弊端，但它们仍然是术前常用的止痛药物。
本研究旨在探讨术前阿片类药物使用剂量对骨科膝关节手术疼痛控制和术后结果及并发症的影响。
观察性、回顾性评估。
威斯康星大学麦迪逊分校医院。
患者于 2014 年 5 月 1 日至 2015 年 4 月 30 日期间接受骨科膝关节手术。我们随机选择了 197 名患者，并将他们分为两组，术前阿片类药物剂量分别为低剂量（≤120mEq 吗啡（MME）或高剂量（>120MME）。197 名患者中，100 名患者为低剂量吗啡组，97 名患者为高剂量组。120MME 的截止值计算为所有患者的中位数剂量。主要结局指标为术后疼痛控制和活动范围（ROM）的差异。次要结局指标包括麻醉并发症、住院时间、术后阿片类药物剂量和术后并发症。
两组在术后疼痛控制、ROM 和即刻术后并发症方面无统计学差异。两组的住院时间（2.199 至 2.304 天；P=0.374）、术后感染率和关节干预均相似。高剂量组更有可能出现术后关节积血和急诊就诊。然而，低剂量组更有可能同时患有高血压。
由于研究时间限制为一年，因此缺乏长期预后数据可能会限制数据的推断。疼痛的主观性难以客观衡量和比较。本研究不是前瞻性随机的，由于未观察到差异，可能会导致某些结果出现偏倚。
术前阿片类药物剂量不会影响接受膝关节手术患者的术后疼痛控制或 ROM。较高的术前阿片类药物剂量与更多的关节积血和急诊就诊有关。进一步探讨生活质量指标和手术并发症（如需要翻修）可能是一个富有成效的途径。
阿片类药物、镇痛、膝关节疼痛、全膝关节置换、膝关节手术、术前阿片类药物、膝关节结果。
