Kamaci Saygin, Ozdemir Erdi, Utz Christopher, Colosimo Angelo
Department of Orthopaedics and Traumatology, Hacettepe University School of Medicine, Ankara, Turkey.
University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Orthop J Sports Med. 2021 Sep 14;9(9):23259671211027546. doi: 10.1177/23259671211027546. eCollection 2021 Sep.
Because of the need for perioperative pain management, orthopaedic surgeons play an important role in opioid use.
PURPOSE/HYPOTHESIS: To evaluate the impact of opioid-limiting legislation on postoperative opioid use and pain-related complications after anterior cruciate ligament reconstruction (ACLR). The hypothesis was that the opioid-limiting legislation would reduce postoperative opioid use after ACLR.
Cohort study; level of evidence, 3.
We retrospectively reviewed patients who underwent ACLR 1 year before and 1 year after Ohio's opioid-limiting legislation, which was passed in August 2017. Clinicians were prohibited from prescribing more than 30 morphine milligram equivalents (MMEs) per day, with a maximum duration of 7 days for adults. The Ohio Automated Rx Reporting System database and patients' medical charts were reviewed for prescriptions of all controlled substances (oral oxycodone, hydrocodone, morphine, codeine, tramadol, and hydromorphone) filled from 30 days before and 90 days after ACLR. The total number of postoperative prescriptions, total MMEs, the number of pills in each patient's prescription, and pain-related complications (emergency department visits, office calls for pain control issues, unplanned readmissions, unplanned surgeries, and provider notes indicating opioid prescription refill demands) were evaluated.
A total of 243 patients (127 prelegislation, 116 postlegislation) were included in the study. There were no significant differences in demographics or preoperative opioid use between the study groups. The number of pills prescribed initially decreased by 34% after legislation (63.5 ± 16.7 [prelegislation] vs 42 ± 15.7 pills [postlegislation]; < .001). Correspondingly, there was a significant decrease in total quantity of initial prescriptions in the postlegislation period (474.6 ± 123.8 vs 310.7 ± 115.3 MMEs; < .001). The number of documented pain medication refill demands and pain-related complications did not increase in the postlegislation period (42 prelegislation vs 43 postlegislation; = .514). Preoperative opioid use was the strongest predictor of opioid-refill demand (odds ratio, 4.19 [95% CI, 1.76-9.99]; = .001).
After the Ohio legislation was passed limiting opioid prescription, there was a significant reduction in opioids provided for patients undergoing ACLR. In spite of this decrease, no rebound increase in refill demands or postoperative pain-related complications were observed.
由于围手术期疼痛管理的需要，骨科医生在阿片类药物的使用中发挥着重要作用。
目的/假设：评估阿片类药物限制立法对前交叉韧带重建（ACLR）术后阿片类药物使用及疼痛相关并发症的影响。假设是阿片类药物限制立法将减少ACLR术后的阿片类药物使用。
队列研究；证据级别，3级。
我们回顾性分析了在俄亥俄州阿片类药物限制立法（于2017年8月通过）之前1年和之后1年接受ACLR的患者。临床医生被禁止每天开具超过30毫克吗啡当量（MME）的处方，成人最长使用期限为7天。对俄亥俄州自动处方报告系统数据库和患者病历进行审查，以获取ACLR术前30天和术后90天内所有管制药物（口服羟考酮、氢可酮、吗啡、可待因、曲马多和氢吗啡酮）的处方。评估术后处方总数、总MME、每位患者处方中的药片数量以及疼痛相关并发症（急诊就诊、因疼痛控制问题的门诊就诊、计划外再入院、计划外手术以及表明阿片类药物处方 refill需求的医生记录）。
共有243例患者（立法前127例，立法后116例）纳入研究。研究组之间在人口统计学或术前阿片类药物使用方面无显著差异。立法后最初开具的药片数量减少了34%（立法前63.5±16.7片 vs 立法后42±15.7片；P<.001）。相应地，立法后时期初始处方的总量显著减少（474.6±123.8 vs 310.7±115.3 MMEs；P<.001）。立法后时期记录的疼痛药物refill需求和疼痛相关并发症的数量没有增加（立法前42例 vs 立法后43例；P=.514）。术前阿片类药物使用是阿片类药物refill需求的最强预测因素（比值比，4.19 [95% CI，1.76 - 9.99]；P=.001）。
俄亥俄州通过限制阿片类药物处方的立法后，接受ACLR的患者所使用的阿片类药物显著减少。尽管有这种减少，但未观察到refill需求或术后疼痛相关并发症的反弹增加。
