Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio, USA.
Department of Orthopaedic Surgery,Brigham and Women's Hospital, Boston, Massachusetts, USA.
Am J Sports Med. 2022 May;50(6):1644-1650. doi: 10.1177/03635465221080788. Epub 2022 Apr 11.
Evidence-based prescribing guidelines are lacking for opioids after most orthopaedic surgical procedures.
Opioids are commonly overprescribed after simple knee arthroscopy.
Case-control study; Level of evidence, 3.
A cohort of 174 patients who underwent simple arthroscopic knee surgery were prospectively evaluated using data from the Outcome Management and Evaluation database. All patients received 10 combined hydrocodone 5 mg and acetaminophen 325 mg pills postoperatively. Patients were excluded if they (1) had revision surgery, (2) had concomitant complex surgery (eg, ligament surgery, osteotomy), (3) had current opioid use, (4) had open surgery for removal of hardware, (5) or had bilateral knee surgery. Total opioid consumption was reported at the first postoperative visit, and a distribution was created based on patient response. Based on the distribution, patients were separated into low (0-2 pills) versus high (3 or more pills) opioid consumption groups for evaluating risk factors for opioid use. The risk factors included were age, body mass index, smoking status, education level, baseline pain (Knee injury and Osteoarthritis Outcome Score pain subscale [KOOS Pain]), and baseline mental health (Veterans RAND 12-Item Health Survey Mental Component Score), as well as intraoperative findings such as synovial characteristics and extent of osteoarthritis in the multivariate model.
Total opioid consumption ranged from 0 to 19 pills. The median pill count was 2 (25th; 75th interquartile range, 0; 4). Of total patients, 59% were categorized as having low opioid consumption, and the remaining 41% were in the high opioid consumption group. Only 23 patients (13.2%) took 6 or more pills. Preoperative pain as measured by KOOS Pain score was a significant predictor of high opioid consumption postoperatively (odds ratio, 0.97; 95% CI, 0.95-0.99; = .003).
The clinically relevant conclusion is that opioids are overprescribed after simple arthroscopic knee surgery. Based on distribution, the authors recommend that 4 pills be prescribed after simple arthroscopic knee surgery. After accounting for confounding variables, preoperative pain was associated with higher postoperative opioid consumption.
大多数骨科手术后缺乏循证医学的阿片类药物处方指南。
在简单的膝关节镜检查后，阿片类药物通常被过度开具。
病例对照研究；证据水平，3 级。
前瞻性评估了来自 Outcome Management and Evaluation 数据库的 174 例接受单纯膝关节镜手术的患者队列。所有患者术后均接受 10 片氢可酮 5 毫克和对乙酰氨基酚 325 毫克联合制剂。如果患者存在以下情况，则将其排除在外：(1) 接受翻修手术，(2) 同时进行复杂手术（如韧带手术、截骨术），(3) 当前正在使用阿片类药物，(4) 因取出内固定物而行开放手术，(5) 或双侧膝关节手术。术后首次就诊时报告总阿片类药物消耗量，并根据患者的反应建立分布。根据分布，将患者分为低（0-2 片）与高（3 片或更多）阿片类药物消耗量组，以评估阿片类药物使用的危险因素。危险因素包括年龄、体重指数、吸烟状况、教育程度、基线疼痛（膝关节损伤和骨关节炎结局评分疼痛亚量表[KOOS 疼痛]）和基线心理健康（退伍军人 RAND 12 项健康调查心理成分评分），以及多变量模型中的术中发现，如滑膜特征和骨关节炎的严重程度。
总阿片类药物消耗量范围为 0 至 19 片。中位数为 2 片（25 百分位；75 百分位间距，0-4）。在所有患者中，59%的患者被归类为低阿片类药物消耗量，其余 41%的患者为高阿片类药物消耗量组。只有 23 名患者（13.2%）服用了 6 片或更多的阿片类药物。术后疼痛评分（KOOS 疼痛评分）是高阿片类药物消耗量的显著预测因素（优势比，0.97；95%置信区间，0.95-0.99；P=0.003）。
简单膝关节镜手术后阿片类药物过度开具的这一临床相关结论表明，术后开具 4 片阿片类药物是合理的。基于分布，作者建议简单膝关节镜手术后开具 4 片阿片类药物。在考虑混杂变量后，术前疼痛与较高的术后阿片类药物消耗相关。
