Department of Orthopedic Surgery, Emory University, Atlanta, GA.
Department of Orthopedic Surgery, Emory University, Atlanta, GA.
J Hand Surg Am. 2022 Sep;47(9):866-873. doi: 10.1016/j.jhsa.2022.06.008.
Perioperative glucocorticoids have been effectively used as a pain management regimen for reducing pain after hand surgery. We hypothesize that a methylprednisolone taper (MPT) course following surgery will reduce pain and opioid consumption in the early postoperative period.
This study was a randomized controlled trial of patients undergoing surgical fixation for distal radius fracture. Before surgery, patients were randomly assigned to receive preoperative dexamethasone only or preoperative dexamethasone followed by a 6-day oral MPT. Patient pain and opioid consumption data were collected for 7 days after surgery using a patient-reported pain journal.
Our study consisted of 56 patients enrolled from November 2018 to March 2020. Twenty-eight patients each were assigned to the control and treatment groups. Demographic characteristics such as age, body mass index, the dominant side affected, smoking status, diabetes status, and current narcotic use were similar between the control and treatment groups. With a noticeable, significant reduction starting on postoperative day 2, patients who received an MPT course consumed substantially less opioids during the first 7 days (7.8 ± 7.2 pills compared with 15.5 ± 11.5 pills, a 50% reduction). These patients also consumed significantly fewer oral morphine equivalents than the control group (81.2 vs 41.2). A significant difference in the pain visual analog scale scores between the 2 groups was noted starting on postoperative day 2, with 48% of the treatment group reporting no pain by postoperative day 6. No adverse events, including infection or complications of wound or bone healing, were seen in either group.
There was an early improvement in pain and reduction in early opioid consumption with a 6-day MPT following surgical fixation for distal radius fracture. With no increased risk of adverse events in our sample, MPT may be a safe and effective way to reduce postoperative pain.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
围手术期糖皮质激素已被有效地用作减轻手部手术后疼痛的疼痛管理方案。我们假设手术后接受甲泼尼龙递减（MPT）疗程将减少术后早期的疼痛和阿片类药物的消耗。
这是一项接受手术固定治疗桡骨远端骨折的患者的随机对照试验。在手术前，患者被随机分配接受术前地塞米松治疗或术前地塞米松联合 6 天的口服 MPT。术后 7 天，使用患者报告的疼痛日记收集患者的疼痛和阿片类药物消耗数据。
我们的研究纳入了 2018 年 11 月至 2020 年 3 月的 56 名患者。每组 28 名患者被分配到对照组和治疗组。两组患者的年龄、体重指数、优势侧、吸烟状况、糖尿病状况和当前阿片类药物使用情况等人口统计学特征相似。从术后第 2 天开始，接受 MPT 疗程的患者明显且显著地减少了前 7 天的阿片类药物消耗（7.8 ± 7.2 片，与 15.5 ± 11.5 片相比减少 50%）。这些患者也比对照组消耗了显著更少的口服吗啡等效物（81.2 对 41.2）。从术后第 2 天开始，两组之间的疼痛视觉模拟评分（VAS）显著不同，治疗组 48%的患者在术后第 6 天报告没有疼痛。两组均未出现感染或伤口或骨骼愈合并发症等不良事件。
桡骨远端骨折手术后接受 6 天 MPT 可早期改善疼痛并减少早期阿片类药物的消耗。在我们的样本中，没有增加不良事件的风险，MPT 可能是减轻术后疼痛的一种安全有效的方法。
研究类型/证据水平：治疗性 II 级。
