From the Pharmacy Department (Mr. Tran, Ms. Castello, Dr. Taylor, Ms. Cannizzaro, Dr. Elliott), Austin Health, Heidelberg, the Centre for Medicine Use and Safety (Mr. Tran, Dr. George, Dr. Elliott), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, and the Orthopaedic Surgery (A/Prof. Hardidge), Austin Health, Heidelberg, Victoria, Australia.
J Am Acad Orthop Surg. 2020 Dec 1;28(23):e980-e989. doi: 10.5435/JAAOS-D-19-00789.
Effective pain management after joint arthroplasty is essential for optimal participation in rehabilitation. However, this needs to be balanced with potential risks associated with opioid use and community exposure. The aim of this study was to evaluate opioid use and appropriateness of supply on discharge after total knee arthroplasty or total hip arthroplasty at a major Australian health service.
A prospective observational study was undertaken at an Australian 980-bed metropolitan health service. Patient interviews were conducted 3 weeks after hospital discharge to evaluate analgesic management and functional outcomes. The primary end point was the number of hospital-supplied opioid pills remaining 3 weeks postdischarge. Secondary end points included (1) factors associated with opioid use 3 weeks postdischarge, (2) opioid use in patients with poor functional outcomes, and (3) proportion of opioid naive patients who became chronic opioid users.
One hundred forty patients were included, and 137 were supplied opioids on discharge. At 3 weeks postdischarge, the median number of opioid pills remaining was 0 (interquartile range 0 to 8). There were 77 patients (56.2%) still taking opioids; surgery type, opioid use before admission, and the number of "as required" doses used 24 hours before discharge were independent predictors of opioid continuation. Patients with poor functional outcomes were supplied with more opioids on discharge, often not satisfied with the quantity supplied and more likely to be taking opioids 3 weeks postdischarge. There were 5 of 93 opioid naive patients (5.3%) who developed chronic opioid usage.
More than half of the patients undergoing total knee arthroplasty or total hip arthroplasty were still using opioids at 3 weeks postdischarge. Most patients were not supplied with excessive quantities at discharge. Future research should focus on identifying patients at risk of prolonged opioid use and improving the transition of these patients into the community.
Level II-Prognostic study = prospective observational study.
关节置换术后有效的疼痛管理对于优化康复参与至关重要。然而，这需要平衡与阿片类药物使用和社区暴露相关的潜在风险。本研究旨在评估在澳大利亚一家大型医疗服务机构进行全膝关节置换术或全髋关节置换术后出院时阿片类药物的使用情况和供应的适当性。
在澳大利亚一家 980 床的大都市医疗服务机构进行了一项前瞻性观察性研究。在出院后 3 周对患者进行访谈，以评估镇痛管理和功能结果。主要终点是出院后 3 周时剩余的医院供应阿片类药物药丸数量。次要终点包括：（1）出院后 3 周阿片类药物使用的相关因素；（2）功能结果不佳的患者的阿片类药物使用情况；（3）成为慢性阿片类药物使用者的阿片类药物初治患者的比例。
共纳入 140 例患者，其中 137 例在出院时给予阿片类药物。出院后 3 周时，剩余阿片类药物药丸的中位数为 0（四分位距 0 至 8）。有 77 例（56.2%）患者仍在服用阿片类药物；手术类型、入院前阿片类药物使用情况以及出院前 24 小时内“按需”使用的剂量数是继续使用阿片类药物的独立预测因素。功能结果不佳的患者出院时给予更多的阿片类药物，往往对供应的数量不满意，并且更有可能在出院后 3 周时服用阿片类药物。在 93 例阿片类药物初治患者中有 5 例（5.3%）发展为慢性阿片类药物使用。
超过一半的全膝关节置换术或全髋关节置换术患者在出院后 3 周时仍在使用阿片类药物。大多数患者出院时并未给予过量的药物。未来的研究应集中于识别有长期阿片类药物使用风险的患者，并改善这些患者向社区的过渡。
II 级-预后研究=前瞻性观察性研究。
