Sabesan Vani J, Chatha Kiran, Koen Sandra, Dawoud Mirelle, Gilot Gregory
Levitetz Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Charles E. Schmidt School of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
JSES Int. 2020 May 4;4(2):362-365. doi: 10.1016/j.jseint.2020.01.005. eCollection 2020 Jun.
The creation of pain as the fifth vital sign led to skyrocketing opioid prescriptions and a crisis with addiction and abuse among Americans. The purpose of this study was to evaluate the effectiveness of a patient engagement model including education and innovative opioid-free multimodal pain management to achieve an opioid-free recovery after shoulder arthroplasty (SA).
Fifty patients undergoing SA were divided into 2 groups. In the opioid-free group (OFG), patients received additional preoperative education in combination with an innovative non-opioid multimodal pain management protocol and non-opioid alternatives. Patients were compared regarding pain levels and opioid consumption at 48 hours and at 2 weeks, as well as patient-reported outcome measures, using Student tests.
No significant differences were found in age (average, 69.76 years) ( = .14), American Society of Anesthesiologists grade (average, 2.25) ( = .24), sex, body mass index (average, 29.5) ( = .34), or comorbidity burden. In the OFG, 24% of patients reported use of rescue opioids (<2 pills) within the first 48 hours after surgery with complete cessation by 2 weeks postoperatively. Comparatively, in the control group, 100% of patients reported using opioids in the first 48 hours after surgery and 80% reported still taking opioids at 2 weeks postoperatively. Patients in both groups showed significant improvements in outcome scores ( ≤ .05), with the OFG reporting significantly higher American Shoulder and Elbow Surgeons pain ( = .036) and Constant ( = .005) scores.
Our findings support complete elimination of opioid use by 2 weeks after SA using a patient engagement model with non-opioid-based alternative pain management. The elimination of opioid pain management did not diminish outcomes or patient satisfaction after SA.
将疼痛列为第五大生命体征导致阿片类药物处方量飙升，美国人面临成瘾和滥用危机。本研究的目的是评估一种患者参与模式的有效性，该模式包括教育和创新的非阿片类多模式疼痛管理，以实现肩关节置换术（SA）后无阿片类药物康复。
50例行SA的患者分为2组。在无阿片类药物组（OFG）中，患者接受额外的术前教育，并结合创新的非阿片类多模式疼痛管理方案和非阿片类替代药物。使用学生t检验比较两组患者在48小时和2周时的疼痛水平、阿片类药物消耗量以及患者报告的结局指标。
两组在年龄（平均69.76岁）（P = 0.14）、美国麻醉医师协会分级（平均2.25）（P = 0.24）、性别、体重指数（平均29.5）（P = 0.34）或合并症负担方面无显著差异。在OFG组中，24%的患者报告在术后头48小时内使用了急救阿片类药物（<2片），术后2周时完全停用。相比之下，在对照组中，100%的患者报告在术后头48小时内使用了阿片类药物，80%的患者报告术后2周仍在服用阿片类药物。两组患者的结局评分均有显著改善（P≤0.05），OFG组报告的美国肩肘外科医师协会疼痛评分（P = 0.036）和康斯坦特评分（P = 0.005）显著更高。
我们的研究结果支持通过采用基于非阿片类替代疼痛管理的患者参与模式，在SA术后2周内完全消除阿片类药物的使用。消除阿片类药物疼痛管理并未降低SA后的结局或患者满意度。
