Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Am J Sports Med. 2020 Sep;48(11):2711-2717. doi: 10.1177/0363546520941861. Epub 2020 Aug 5.
Orthopaedic surgeons have a responsibility to develop responsible opioid practices. Growing evidence has helped define an optimal number of opioids to prescribe after surgical procedures, but little evidence-based guidance exists to support specific practice patterns to decrease opioid utilization.
After knee arthroscopic surgery with partial meniscectomy, patients who were provided a prescription for opioids and instructed to only fill the prescription if absolutely necessary for pain control would take fewer opioids than patients with opioids automatically included as part of a multimodal approach to pain control prescribed at discharge.
Randomized controlled trial; Level of evidence, 2.
Patients undergoing arthroscopic partial meniscectomy were provided multimodal pain control with aspirin, acetaminophen, and naproxen and randomized to receive oxycodone as either included with their multimodal pain medications (group 1) or given an optional prescription to fill (group 2). Patients were contacted at time points up to 1 month after surgery to assess opioid utilization and medication side effects. The mean number of tablets utilized was the primary outcome measure, with a 50% reduction defined as a successful outcome.
A total of 105 patients were initially enrolled, and 95 (91%; 48 in group 1 and 47 in group 2) successfully completed the study. There was no significant reduction in the number of tablets utilized between groups 1 and 2 (3.5 vs 4.5, respectively; = .45), days that opioids were required (2.2 vs 3.2, respectively; = .20), or postoperative pain at any time point. The group with the option to fill their prescription had significantly fewer unused tablets remaining than the group with opioids included as part of the multimodal pain control regimen (75% of potentially prescribed tablets vs 82% of prescribed tablets; < .001). Overall, 37% of patients did not require any opioids after surgery, and 86% used ≤8 tablets.
Patients required a minimal number of opioids after knee arthroscopic surgery with partial meniscectomy. There was no difference in the number of tablets utilized whether the opioid prescription was included in a multimodal pain control regimen or patients were given an option to fill the prescription. Offering optional opioid prescriptions in the setting of a multimodal approach to pain control can significantly reduce the number of unused opioids circulating in the community.
NCT03876743 (ClinicalTrials.gov identifier).
矫形外科医生有责任制定负责任的阿片类药物使用规范。越来越多的证据已经帮助确定了手术后开具的阿片类药物的最佳剂量，但几乎没有基于证据的指导来支持减少阿片类药物使用的具体实践模式。
膝关节镜下半月板部分切除术患者，如果被开具阿片类药物处方，并被告知仅在疼痛控制绝对必要时才去配药，那么与阿片类药物自动纳入多模式疼痛控制方案的患者相比，他们的阿片类药物用量会更少。
随机对照试验；证据水平，2 级。
接受关节镜下半月板部分切除术的患者接受了阿司匹林、对乙酰氨基酚和萘普生的多模式疼痛控制，并随机接受羟考酮，或作为其多模式疼痛药物的一部分（第 1 组），或给予可选的处方（第 2 组）。在手术后的时间点，患者被联系以评估阿片类药物的使用情况和药物副作用。使用的片剂平均数量是主要观察指标，定义 50%的减少为成功结果。
共有 105 名患者最初入组，其中 95 名（91%；第 1 组 48 名，第 2 组 47 名）成功完成了研究。第 1 组和第 2 组之间使用的片剂数量没有显著减少（分别为 3.5 和 4.5；=.45），需要使用阿片类药物的天数（分别为 2.2 和 3.2；=.20），或任何时间点的术后疼痛。有选择处方的组剩余未使用的片剂明显少于阿片类药物纳入多模式疼痛控制方案的组（潜在处方片剂的 75%比处方片剂的 82%；<.001）。总体而言，37%的患者术后不需要任何阿片类药物，86%的患者使用≤8 片。
膝关节镜下半月板部分切除术后，患者需要的阿片类药物数量最少。无论阿片类药物处方是纳入多模式疼痛控制方案还是患者有选择处方的机会，使用的片剂数量都没有差异。在多模式疼痛控制方案中提供可选的阿片类药物处方可以显著减少社区中流通的未使用阿片类药物的数量。
NCT03876743（ClinicalTrials.gov 标识符）。
