Malige Ajith, Bram Joshua T, Maguire Kathleen J, McNeely Lia W, Ganley Theodore J, Williams Brendan A
Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA.
Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Orthop J Sports Med. 2021 Feb 1;9(2):2325967120979993. doi: 10.1177/2325967120979993. eCollection 2021 Feb.
Anterior cruciate ligament (ACL) injury is common in the pediatric population. Pain control after ACL reconstruction (ACLR) presents a unique challenge due to age and early rehabilitation needs. Pain management practices are believed to have evolved in recent years to limit unnecessary exposure to risks associated with opioid use in this vulnerable population.
To describe trends in postoperative opioid prescribing and assess factors including obtaining consent for opioid prescribing for minors that may have mitigated excessive prescription of opioids.
Cohort study; Level of evidence, 3.
This is a retrospective review of a consecutive series of pediatric patients (<18 years) undergoing primary ACLR within an urban academic hospital system over a 5-year period (2014-2018). The study period included the gradual introduction of preoperative consenting for opioid use in minors as mandated by state law in 2016. Patient characteristics, surgical details, presence of a signed consent form to prescribe opioid medications, prescribed postoperative medications, prescriber, and indicators of inadequate pain control were collected. Univariate and multivariate analyses were performed to determine factors associated with reduced postoperative opioid prescribing.
This study included 687 patients with a mean age of 15.1 ± 1.9 years, with less than one-third of patients having preoperative consent forms to prescribe opioid medications. Postoperative prescribing trends demonstrated a decline in the number of opioid doses provided and increased utilization of nonopioid medications. Patients who received preoperative opioid counseling and signed a consent form were prescribed fewer opioids and had a smaller number of unscheduled contacts for poorly controlled pain. Univariate analyses identified multiple predictors of the number of opioid doses prescribed postoperatively. Obtaining preoperative consent to prescribe opioids and ambulatory surgery center location were found to be independent predictors of prescribed doses in the multivariate analysis.
The quantity of opioid medication prescribed for pain management after pediatric ACLR at our institution has declined in recent years. This appears to be, in part, related to state-mandated preoperative counseling about opioid use, signing of a consent form by the parent(s) or guardian(s) to prescribe opioids to minors, and encouragement toward the use of nonopioid medications when possible. Preoperative opioid use discussions in the pediatric population may be useful in reducing opioid overprescription and utilization in this population.
前交叉韧带（ACL）损伤在儿童群体中很常见。由于年龄和早期康复需求，ACL重建（ACLR）后的疼痛控制面临独特挑战。近年来，疼痛管理方法不断发展，以减少在这一脆弱群体中不必要地接触与使用阿片类药物相关的风险。
描述术后阿片类药物处方趋势，并评估包括为未成年人开具阿片类药物处方获得同意等可能减轻阿片类药物过度处方的因素。
队列研究；证据等级，3级。
这是一项对城市学术医院系统内5年期间（2014 - 2018年）连续进行初次ACLR的儿科患者（<18岁）的回顾性研究。研究期间包括2016年州法律规定逐步引入的未成年人使用阿片类药物的术前同意程序。收集患者特征、手术细节、开具阿片类药物的签署同意书、术后开具的药物、开处方者以及疼痛控制不足的指标。进行单因素和多因素分析以确定与术后阿片类药物处方减少相关的因素。
本研究纳入687例患者，平均年龄15.1±1.9岁，不到三分之一的患者有开具阿片类药物的术前同意书。术后处方趋势显示提供的阿片类药物剂量数量下降，非阿片类药物的使用增加。接受术前阿片类药物咨询并签署同意书的患者开具的阿片类药物较少，因疼痛控制不佳进行的非计划联系次数也较少。单因素分析确定了术后阿片类药物剂量数量的多个预测因素。多因素分析发现，获得术前开具阿片类药物的同意以及门诊手术中心位置是开具剂量的独立预测因素。
近年来，我们机构为儿科ACLR后疼痛管理开具的阿片类药物数量有所下降。这似乎部分与州规定的关于阿片类药物使用的术前咨询、父母或监护人签署为未成年人开具阿片类药物的同意书以及鼓励尽可能使用非阿片类药物有关。儿科人群中术前关于阿片类药物使用的讨论可能有助于减少该人群中阿片类药物的过度处方和使用。
