Barnett Samuel, Murray Martha M, Liu Shanshan, Micheli Lyle J
Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital Boston, Massachusetts, U.S.A.
Institutional Centers for Clinical and Translational Research, Boston Children's Hospital Boston, Massachusetts, U.S.A.
Arthrosc Sports Med Rehabil. 2020 May 14;2(3):e219-e228. doi: 10.1016/j.asmr.2020.02.004. eCollection 2020 Jun.
To compare postoperative pain scores and opioid use between patients undergoing a standard arthroscopic anterior cruciate ligament reconstruction (ACLR) using hamstring autograft with those undergoing a suture repair augmented with an extracellular matrix scaffold (bridge-enhanced ACL repair) performed through an arthrotomy and to determine factors predictive of postoperative opioid use and levels of overprescription.
A nonrandomized controlled trial was conducted with 20 patients (10 ACLR, 10 bridge-enhanced ACL repair), aged 18 to 35 years. All surgeries were performed by a single surgeon. A pain medication log was provided to patients on discharge. No regional anesthesia was performed. Pain scores via a visual analog pain scale were recorded at each visit. Correlations between preoperative and intraoperative characteristics and postoperative opioid use were determined.
The total morphine-equivalent dose ranged from 30 to 309 mg (4-42 pills oxycodone) for the ACLR group and 75 to 254 mg (10-34 pills oxycodone) for the bridge-enhanced ACL repair group. The average opioid use per day was 35.8 mg for the patients undergoing bridge-enhanced ACL repair and 44.2 mg for patients undergoing ACLR ( = .29). Pain scores at time points up to 2 years postoperatively were not significantly different between the 2 groups. Across both groups, the average oversupply of oxycodone was 46 pills per patient, a greater than 70% unused opiate rate. Preoperative body mass index and preoperative Knee Injury and Osteoarthritis Outcome Scores pain score were predictive of greater postoperative opioid use per day, whereas age, concurrent meniscal repair, and operative time were not.
Total overall opiate intake was not different between the patients undergoing bridge-enhanced ACL repair through an arthrotomy and those undergoing arthroscopic ACLR. Both groups had similar pain scores from 2 weeks to 2 years postoperatively. Greater body mass index and greater preoperative pain (lower Knee Injury and Osteoarthritis Outcome Scores pain score) correlated with greater postoperative opioid use per day. There was an overprescription of opioids across all patients.
Level III, case control study (therapeutic).
比较采用自体腘绳肌腱进行标准关节镜下前交叉韧带重建术（ACLR）的患者与通过关节切开术进行细胞外基质支架增强缝合修复术（桥接增强ACL修复术）的患者术后疼痛评分和阿片类药物使用情况，并确定预测术后阿片类药物使用及处方过量水平的因素。
对20例年龄在18至35岁之间的患者（10例行ACLR，10例行桥接增强ACL修复术）进行了一项非随机对照试验。所有手术均由同一位外科医生进行。出院时为患者提供了疼痛药物记录。未实施区域麻醉。每次就诊时通过视觉模拟疼痛量表记录疼痛评分。确定术前和术中特征与术后阿片类药物使用之间的相关性。
ACLR组的吗啡当量总量为30至309毫克（4至42片羟考酮），桥接增强ACL修复组为75至254毫克（10至34片羟考酮）。接受桥接增强ACL修复术的患者每天平均阿片类药物使用量为35.8毫克，接受ACLR的患者为44.2毫克（P = 0.29）。两组术后2年内各时间点的疼痛评分无显著差异。在两组中，羟考酮的平均过量供应量为每位患者46片，未使用阿片类药物的比例超过70%。术前体重指数和术前膝关节损伤与骨关节炎疗效评分疼痛评分可预测术后每天更高的阿片类药物使用量，而年龄、同时进行的半月板修复和手术时间则不能。
通过关节切开术进行桥接增强ACL修复术的患者与接受关节镜下ACLR的患者的阿片类药物总摄入量无差异。两组术后2周内至2年的疼痛评分相似。更高的体重指数和更高的术前疼痛程度（更低的膝关节损伤与骨关节炎疗效评分疼痛评分）与术后每天更高的阿片类药物使用量相关。所有患者均存在阿片类药物处方过量的情况。
III级，病例对照研究（治疗性）
