术前患者教育和减少处方数量可减少青少年特发性脊柱侧凸后路脊柱融合术后阿片类药物的使用：一项前瞻性研究的结果。
Preoperative Patient Education and Smaller Prescription Quantity Reduce Opioid Use After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: Results of a Prospective Study.
机构信息
Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI.
出版信息
J Pediatr Orthop. 2022 Sep 1;42(8):e868-e873. doi: 10.1097/BPO.0000000000002215. Epub 2022 Jul 20.
BACKGROUND
Most opioids prescribed postoperatively are unused. Leftover opioids are a major source of nonmedical opioid use among adolescents. Postoperative opioid use has also been associated with prescription quantity. Our purpose was to evaluate the effect of preoperative patient education and implementation of evidence-based prescribing guidelines on opioid use and pain level after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).
METHODS
AIS patients aged 10 to 17 years undergoing PSF were prospectively enrolled [postintervention cohort (POST-INT)]. Previous data on 77 patients showed median consumption of 29 doses of oxycodone after PSF [preintervention cohort (PRE-INT)]. All eligible patients during the study period were discharged with 30 doses of oxycodone and standard nonopioid analgesics. Only study participants received education on postoperative pain control. Demographics, radiographic/surgical data, pain level, and patient-reported outcomes were collected. Requests for opioid refills were documented.
RESULTS
Forty-nine patients were enrolled. POST-INT was divided into low (L, ≤8 doses), average (AVE, 9-25), and high (H, >25) opioid use groups. Demographics, radiographic/surgical data, pain level, and patient-reported outcomes were similar between the groups. However, there was a difference in days of oxycodone use, doses consumed in the first week, and leftover doses ( P <0.001). Comparison to the PRE-INT L (≤16 doses), AVE (17 to 42), and high (H, >42) use groups showed that POST-INT L and AVE consumed less oxycodone (L: P =0.002; AVE: P <0.001). Also, the overall POST-INT cohort had fewer mean days of oxycodone use (5.6 vs. 8.9, P <0.001) and doses used in the first week (14 vs. 23, P <0.001) compared with the PRE-INT cohort. Subanalysis showed fewer study participants requested and received an opioid refill [3/49 patients (6%)] compared with eligible patients who declined to participate, withdrew, or missed enrollment [8/35 patients (23%)] ( P =0.045).
CONCLUSIONS
Preoperative patient education and smaller prescription quantity successfully reduced opioid use while maintaining excellent pain control after PSF for AIS. Setting expectations regarding postoperative pain management is critical, as nonstudy participants were significantly more likely to request an opioid refill.
LEVEL OF EVIDENCE
Level II-therapeutic.
背景
大多数术后开具的阿片类药物未被使用。剩余的阿片类药物是青少年非医疗性阿片类药物使用的主要来源。术后阿片类药物的使用也与处方数量有关。我们的目的是评估术前患者教育和实施基于证据的处方指南对青少年特发性脊柱侧凸（AIS）后路脊柱融合术（PSF）后阿片类药物使用和疼痛水平的影响。
方法
前瞻性纳入年龄在 10 至 17 岁接受 PSF 的 AIS 患者[干预后队列（POST-INT）]。先前的数据显示，77 例患者在 PSF 后平均使用 29 剂羟考酮[干预前队列（PRE-INT）]。研究期间所有符合条件的患者出院时均携带 30 剂羟考酮和标准非阿片类镇痛药。只有研究参与者接受了术后疼痛控制教育。收集人口统计学、影像学/手术数据、疼痛水平和患者报告的结果。记录阿片类药物的补充要求。
结果
共纳入 49 例患者。POST-INT 分为低（L，≤8 剂）、中（AVE，9-25）和高（H，>25）阿片类药物使用组。各组之间的人口统计学、影像学/手术数据、疼痛水平和患者报告的结果相似。然而，在羟考酮使用天数、第 1 周消耗的剂量和剩余剂量方面存在差异（P<0.001）。与 PRE-INT 的 L（≤16 剂）、AVE（17-42 剂）和 H（>42 剂）使用组相比，POST-INT 的 L 和 AVE 消耗的羟考酮更少（L：P=0.002；AVE：P<0.001）。此外，与 PRE-INT 队列相比，总体 POST-INT 队列的羟考酮使用天数（5.6 天 vs. 8.9 天，P<0.001）和第 1 周使用的剂量（14 剂 vs. 23 剂，P<0.001）均更少。亚组分析显示，与未参与研究的合格患者相比，请求并接受阿片类药物补充的研究参与者较少[49 例患者中的 3 例（6%）]，拒绝参与、退出或错过入组的患者较多[35 例患者中的 8 例（23%）]（P=0.045）。
结论
术前患者教育和较小的处方量成功减少了阿片类药物的使用，同时在 AIS 后路脊柱融合术后保持了良好的疼痛控制。设定对术后疼痛管理的期望至关重要，因为非研究参与者更有可能要求阿片类药物补充。
证据水平
II 级-治疗性。
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