Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston.
Division of Plastic Surgery, Hand Surgery, and Peripheral Nerve Surgery, Massachusetts General Hospital, Harvard Medical School, Boston.
J Reconstr Microsurg. 2022 Feb;38(2):137-143. doi: 10.1055/s-0041-1731640. Epub 2021 Jul 16.
Identifying patients at risk for prolonged opioid use following surgery for symptomatic neuroma would be beneficial for perioperative management. The aim of this study is to identify the factors associated with postoperative opioid use of >4 weeks in patients undergoing neuroma surgery.
After retrospective identification, 77 patients who underwent surgery for symptomatic neuroma of the upper or lower extremity were enrolled. Patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) depression, Numeric Rating Scale (NRS) pain score, and a custom medication questionnaire at a median of 9.7 years (range: 2.5-16.8 years) following surgery. Neuroma excision followed by nerve implantation ( = 39, 51%), nerve reconstruction/repair ( = 18, 23%), and excision alone ( = 16, 21%) were the most common surgical treatments.
Overall, 27% ( = 21) of patients reported opioid use of more than 4 weeks postoperatively. Twenty-three patients (30%) reported preoperative opioid use of which 11 (48%) did not report opioid use for >4 weeks, postoperatively. In multivariable logistic regression, preoperative opioid use was independently associated with opioid use of >4 weeks, postoperatively (odds ratio [OR] = 4.4, 95% confidence interval [CI]: 1.36-14.3, = 0.013).
Neuroma surgery reduces opioid use in many patients but patients who are taking opioids preoperatively are at risk for longer opioid use. Almost one-third of patients reported opioid use longer than 4 weeks, postoperatively.
对于因症状性神经瘤而行手术治疗的患者，识别出术后可能需要长期使用阿片类药物的患者，将有助于围手术期管理。本研究旨在确定与术后 4 周以上阿片类药物使用相关的因素。
回顾性鉴定后，纳入 77 例行上肢或下肢症状性神经瘤手术的患者。患者在术后中位数 9.7 年（范围：2.5-16.8 年）时完成了患者报告的结局测量信息系统（PROMIS）抑郁量表、数字评分量表（NRS）疼痛评分和自定义药物问卷。神经瘤切除后植入神经（ = 39，51%）、神经重建/修复（ = 18，23%）和单纯切除（ = 16，21%）是最常见的手术治疗方法。
总体而言，27%（ = 21）的患者报告术后阿片类药物使用超过 4 周。23 名患者（30%）报告术前使用阿片类药物，其中 11 名（48%）患者术后未报告使用阿片类药物超过 4 周。多变量逻辑回归显示，术前使用阿片类药物与术后使用阿片类药物超过 4 周独立相关（比值比[OR] = 4.4，95%置信区间[CI]：1.36-14.3， = 0.013）。
神经瘤手术可使许多患者减少阿片类药物的使用，但术前使用阿片类药物的患者存在长期使用阿片类药物的风险。近三分之一的患者报告术后阿片类药物使用时间超过 4 周。
