Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2021 Jun;150:e600-e612. doi: 10.1016/j.wneu.2021.03.066. Epub 2021 Mar 19.
To identify spine patients' barriers to appropriate postoperative opioid use, comfort with naloxone, knowledge of safe opioid disposal practices, and associated factors.
We preoperatively surveyed 174 spine patients about psychobehavioral barriers to appropriate opioid use, comfort with naloxone, and knowledge about opioid disposal. Multivariable logistic regression identified factors associated with barriers and knowledge (α = 0.05).
Common barriers were fear of addiction (71%) and concern about disease progression (43%). Most patients (78%) had neutral/low confidence in the ability of nonopioid medications to control pain; most (57%) felt neutral or uncomfortable with using naloxone; and most (86%) were familiar with safe disposal. Anxiety was associated with fear of distracting the physician (adjusted odds ratio [aOR], 3.8; 95% confidence interval [CI], 1.1-14) and with lower odds of knowing safe disposal methods (aOR, 0.18; 95% CI, 0.04-0.72). Opioid use during the preceding month was associated with comfort with naloxone (aOR, 4.9; 95% CI, 2.1-12). Patients with a higher educational level had lower odds of reporting fear of distracting the physician (aOR, 0.30; 95% CI, 0.09-0.97), and those with previous postoperative opioid use had lower odds of concern about disease progression (aOR, 0.25; 95% CI, 0.09-0.63) and with a belief in tolerating pain (aOR, 0.34; 95% CI, 0.12-0.95).
Many spine patients report barriers to appropriate postoperative opioid use and are neutral or uncomfortable with naloxone. Some are unfamiliar with safe disposal. Associated factors include anxiety, lack of recent opioid use, and no previous postoperative use.
确定脊柱患者在适当使用术后阿片类药物方面的障碍、对纳洛酮的舒适度、对安全阿片类药物处理方法的了解，以及相关因素。
我们对 174 名脊柱患者进行了术前调查，内容包括适当使用阿片类药物的心理行为障碍、对纳洛酮的舒适度以及对阿片类药物处理的了解。多变量逻辑回归确定了与障碍和知识相关的因素（α=0.05）。
常见的障碍包括对成瘾的恐惧（71%）和对疾病进展的担忧（43%）。大多数患者（78%）对非阿片类药物控制疼痛的能力持中立/低信心；大多数（57%）对使用纳洛酮感到中立或不舒服；大多数（86%）熟悉安全处置方法。焦虑与担心分散医生注意力的可能性相关（调整后的优势比[OR]，3.8；95%置信区间[CI]，1.1-14），并且不太可能知道安全处置方法（OR，0.18；95%CI，0.04-0.72）。在过去一个月中使用阿片类药物与对纳洛酮的舒适度相关（OR，4.9；95%CI，2.1-12）。受教育程度较高的患者报告担心分散医生注意力的可能性较低（OR，0.30；95%CI，0.09-0.97），而有过术后阿片类药物使用史的患者对疾病进展的担忧（OR，0.25；95%CI，0.09-0.63）和忍受疼痛的信念（OR，0.34；95%CI，0.12-0.95）较低。
许多脊柱患者报告在适当使用术后阿片类药物方面存在障碍，对纳洛酮感到中立或不舒服。有些人对安全处置方法不熟悉。相关因素包括焦虑、近期无阿片类药物使用以及无术后使用史。
