Dell Medical School, University of Texas, Austin.
Orthopaedic Institute for Children/UCLA, Los Angeles.
J Pediatr Orthop. 2023 Apr 1;43(4):e278-e283. doi: 10.1097/BPO.0000000000002344. Epub 2023 Jan 9.
The opioid epidemic in the United States is a public health crisis. Pediatric orthopaedic surgeons must balance adequate pain management with minimizing the risk of opioid misuse or dependence. There is limited data available to guide pain management for anterior cruciate ligament reconstruction (ACLR) in the pediatric population. The purpose of this study was to survey current pain management practices for ACLR among pediatric orthopaedic surgeons.
A cross-sectional survey study was conducted, in which orthopaedic surgeons were asked about their pain management practices for pediatric ACLR. The voluntary survey was sent to members of the Pediatric Orthopaedic Society of North America. Inclusion criteria required that the surgeon perform anterior cruciate ligament repair or reconstruction on patients under age 18. Responses were anonymous and consisted of surgeon demographics, training, practice, and pain management strategies. Survey data were assessed using descriptive statistics.
Of 64 included responses, the average age of the survey respondent was 48.9 years, 84.4% were males, and 31.3% practiced in the southern region of the United States. Preoperative analgesia was utilized by 39.1%, 90.6% utilized perioperative blocks, and 89.1% prescribed opioid medication postoperatively. For scheduled non-narcotic medications postoperatively 82.8% routinely advocated and 93.8% recommended cryotherapy postoperatively.Acetaminophen was the most used preoperative medication (31.3%), the most common perioperative block was an adductor canal block (81.0%), and the most common postoperative analgesic medication was ibuprofen (60.9%). Prior training or experience was more frequently reported than published research as a primary factor influencing pain management protocols.
Substantial variability exists in pain management practices in pediatric ACLR. There is a need for more evidence-based practice guidelines regarding pain management.
Level V.
美国的阿片类药物泛滥是一场公共卫生危机。小儿矫形外科医生必须在充分的疼痛管理和最小化阿片类药物滥用或依赖的风险之间取得平衡。目前，针对小儿前交叉韧带重建（ACLR）的疼痛管理，可提供的指导数据有限。本研究旨在调查小儿矫形外科医生目前对 ACLR 的疼痛管理做法。
进行了一项横断面调查研究，其中要求矫形外科医生就小儿 ACLR 的疼痛管理实践回答问题。这项自愿调查是发给北美小儿矫形外科学会的成员的。纳入标准要求外科医生对 18 岁以下的患者进行前交叉韧带修复或重建。回复是匿名的，包括外科医生的人口统计学、培训、实践和疼痛管理策略。使用描述性统计评估调查数据。
在 64 份纳入的回复中，调查回复者的平均年龄为 48.9 岁，84.4%为男性，31.3%在美国南部地区执业。39.1%的患者术前使用了镇痛剂，90.6%的患者使用了围手术期阻滞，89.1%的患者术后开具了阿片类药物。82.8%的患者常规推荐术后定期使用非麻醉性药物，93.8%的患者推荐术后行冷冻疗法。术前最常用的药物是对乙酰氨基酚（31.3%），最常用的围手术期阻滞是收肌管阻滞（81.0%），最常用的术后镇痛药物是布洛芬（60.9%）。与发表的研究相比，更多的人报告称之前的培训或经验是影响疼痛管理方案的主要因素。
小儿 ACLR 的疼痛管理实践存在很大差异。需要更多基于证据的实践指南来指导疼痛管理。
5 级。
