Sundling Rebecca A, Logan Daniel B, Tawancy Cherreen H, So Eric, Lee Jonathan, Logan Kaitlyn
Foot and Ankle Specialists of West Michigan, 2144 E. Paris Ave SE, Suite 100, Grand Rapids, MI, 49503, USA.
Foot and Ankle Specialists of Central Ohio, 426A Beecher Road, Gahanna, OH, 43230, USA.
Foot (Edinb). 2020 Dec;45:101710. doi: 10.1016/j.foot.2020.101710. Epub 2020 Jul 13.
Prescription of opioids following surgery is commonplace in the United States, but with that has come increases in misuse, overdose and death. Evaluating prescribing habits in efforts to reduce the opioid epidemic is becoming more frequent. The purpose of the present study was to examine the self-reported practices of podiatric surgeons regarding their methods of post-operative pain management in adult, sensate patients, as well as assessing the frequency of use of adjunctive pain control modalities. A survey was created and distributed to Podiatric Surgeons electronically, across the United States. Results of this study show that Podiatric Surgeons prescribe hydrocodone/acetaminophen most commonly after surgery, with most prescribing opioids for less than 2 weeks. With regards to adjunctive pain management, two-thirds of respondents use regional anesthesia blocks, with only 13% using post-anesthesia delivery devices (PADD). Interestingly, those using PADDs prescribed significantly more opioids at the first prescription and were more likely to refill the prescription. Podiatric Surgeons are concerned with various negative outcomes for their patients when taking opioids, including addiction, non-adherence, and motor vehicle accidents. Podiatric Surgeons are less concerned about negative outcomes for themselves when prescribing opioids. This study is in agreement with previously published studies in other medical specialties regarding opioid prescribing habits and concerns. However, further research is needed to fully understand the role PADDs and regional anesthesia blocks play in reducing the amount of opioids prescribed following surgery. The Opioid Epidemic in the United States is multi-faceted, but over-prescription by providers is part of it. Continuing to assess and understand how opioids are prescribed will be paramount to curb the epidemic.
在美国，术后开具阿片类药物的处方很常见，但随之而来的是滥用、过量使用和死亡人数的增加。为减少阿片类药物流行而评估处方习惯的情况越来越频繁。本研究的目的是调查足病外科医生在成人有感觉的患者术后疼痛管理方法方面的自我报告做法，并评估辅助疼痛控制方式的使用频率。创建了一项调查并通过电子方式分发给美国各地的足病外科医生。这项研究的结果表明，足病外科医生术后最常开具氢可酮/对乙酰氨基酚，大多数人开具阿片类药物的时间少于2周。关于辅助疼痛管理，三分之二的受访者使用区域麻醉阻滞，只有13%的人使用麻醉后给药装置（PADD）。有趣的是，使用PADD的人在首次开处方时开具的阿片类药物明显更多，而且更有可能再次开处方。足病外科医生在患者服用阿片类药物时担心各种负面后果，包括成瘾、不依从和机动车事故。足病外科医生在开具阿片类药物时对自身负面后果的担忧较少。本研究与之前其他医学专科发表的关于阿片类药物处方习惯和担忧的研究一致。然而，需要进一步研究以充分了解PADD和区域麻醉阻滞在减少术后阿片类药物处方量方面所起的作用。美国的阿片类药物流行是多方面的，但医疗服务提供者的过度处方是其中一部分。持续评估和了解阿片类药物的处方方式对于遏制这一流行至关重要。
