Nadarajah Vidushan, Meredith Sean J, Jauregui Julio J, Smuda Michael P, Medina Shaun, Gilotra Mohit N, Hasan S Ashfaq, Henn R Frank
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.
Shoulder Elbow. 2021 Jun;13(3):248-259. doi: 10.1177/1758573219879689. Epub 2019 Oct 17.
Opioids are commonly used to manage pain from acute injury or chronic degenerative diseases. The objective of this study was to assess the prevalence of preoperative opioid use in patients undergoing shoulder surgery and the clinical factors associated with preoperative opioid use.
This was an analytical cross-sectional study of 175 patients undergoing shoulder surgery at an urban hospital from June 2015 to June 2017. Multivariable regression models were used to determine independent associations.
Fifty-three patients reported preoperative opioid use, which was significantly associated with primary procedure performed (Current Procedural Terminology [CPT]), higher body mass index (BMI), unemployment, lower income, smoking, higher American Society of Anesthesiologists score, greater number of previous surgeries, higher comorbidity burden, and decreased expectations to exercise and do recreational activities (p < 0.05). Preoperative opioid use was independently associated with worse scores on the: Numeric Pain Scale, ASES, IPAQ, and PROMIS domains of Physical Function, Pain Interference, and Social Satisfaction (p < 0.05).
More than one in four patients reported preoperative opioid use. Several health measures, including worse pain, function, and social satisfaction were independently associated with preoperative opioid use. These findings suggest that orthopaedic surgeons need to identify patients using opioids preoperatively in order to effectively establish and execute a plan for pain management, which may include weaning off opioids prior to surgery, managing psychological distress, and optimizing coping strategies.: III.
阿片类药物常用于处理急性损伤或慢性退行性疾病引起的疼痛。本研究的目的是评估接受肩部手术患者术前使用阿片类药物的患病率以及与术前使用阿片类药物相关的临床因素。
这是一项对2015年6月至2017年6月期间在一家城市医院接受肩部手术的175例患者进行的分析性横断面研究。采用多变量回归模型来确定独立关联。
53例患者报告术前使用阿片类药物，这与所进行的主要手术（当前手术操作术语[CPT]）、较高的体重指数（BMI）、失业、低收入、吸烟、较高的美国麻醉医师协会评分、既往手术次数较多、较高的合并症负担以及对运动和进行娱乐活动的期望降低显著相关（p<0.05）。术前使用阿片类药物与数字疼痛量表、ASES、IPAQ以及身体功能、疼痛干扰和社会满意度的PROMIS领域得分较差独立相关（p<0.05）。
超过四分之一的患者报告术前使用阿片类药物。包括更严重的疼痛、功能和社会满意度在内的多项健康指标与术前使用阿片类药物独立相关。这些发现表明，骨科医生需要识别术前使用阿片类药物的患者，以便有效地制定和实施疼痛管理计划，这可能包括在手术前停用阿片类药物、处理心理困扰以及优化应对策略。：III级。
