University of Michigan Medical School, Ann Arbor, Michigan, USA.
Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA.
Pain Med. 2022 Jan 3;23(1):19-28. doi: 10.1093/pm/pnab322.
Most studies on preoperative opioid use only describe whether or not patients use opioids without characterizing reasons for use. Knowing why patients use opioids can help inform perioperative opioid management. The objective of this study was to explore pain specific reasons for preoperative opioid use prior to total hip and knee arthroplasty (THA and TKA) and their association with persistent use.
This is a prospective study of 197 patients undergoing THA (n = 99) or TKA (n = 98) enrolled in the Analgesic Outcomes Study between December 2015 and November 2018. All participants reported preoperative opioid use.
Reasons for preoperative opioid use were categorized as surgical site pain only (81 [41.1%]); pain in other body areas only (22 [11.2%]); and combined pain (94 [47.7%]). Compared to patients taking opioids for surgical site pain, those with combined reasons for use had 1.24 (P = .40) and 2.28 (P = .16) greater odds of persistent use at 3 and 6 months postoperatively, adjusting for relevant covariates.
This study provides novel insights into the heterogeneity of reasons for presurgical opioid use in patients undergoing a THA or TKA. One key take away is that not all preoperative opioid use is the same and many patients are taking opioids preoperatively for more than just pain at the surgical site. Combined reasons for use was associated with long-term use, suggesting nonsurgical pain, in part, drives persistent opioid use after surgery. Future directions in perioperative care should focus on pain and non-pain reasons for presurgical opioid use to create tailored postoperative opioid weaning plans.
大多数关于术前使用阿片类药物的研究仅描述了患者是否使用阿片类药物，而没有描述使用的原因。了解患者使用阿片类药物的原因可以帮助我们了解围手术期阿片类药物管理。本研究旨在探讨全髋关节置换术（THA）和全膝关节置换术（TKA）术前使用阿片类药物的疼痛特异性原因及其与持续使用的关系。
这是一项前瞻性研究，纳入了 2015 年 12 月至 2018 年 11 月期间参与镇痛结局研究的 197 例接受 THA（n=99）或 TKA（n=98）的患者。所有参与者均报告了术前使用阿片类药物的情况。
术前使用阿片类药物的原因分为手术部位疼痛（81[41.1%]）、其他身体部位疼痛（22[11.2%]）和混合疼痛（94[47.7%]）。与仅因手术部位疼痛而使用阿片类药物的患者相比，因混合原因使用阿片类药物的患者在术后 3 个月和 6 个月时持续使用的可能性分别增加了 1.24（P=0.40）和 2.28（P=0.16），校正了相关协变量。
本研究提供了关于接受 THA 或 TKA 患者术前使用阿片类药物的原因异质性的新见解。一个重要的结论是，并非所有术前使用阿片类药物的情况都相同，许多患者术前不仅因手术部位疼痛而使用阿片类药物。混合原因使用与长期使用相关，表明非手术性疼痛部分导致术后持续使用阿片类药物。围手术期护理的未来方向应侧重于术前使用阿片类药物的疼痛和非疼痛原因，以制定个体化的术后阿片类药物减药计划。
