小儿运动矫形外科术后疼痛药物的利用：描述患者使用模式和阿片类药物保留。
Postoperative Pain Medication Utilization in Pediatric Patients Undergoing Sports Orthopaedic Surgery: Characterizing Patient Usage Patterns and Opioid Retention.
机构信息
From the Department of Orthopaedics, University of Utah, Salt Lake City, UT (Metz, Dr. Tomasevich, Rosenthal, Dr. Featherall, and Dr. Aoki), and the School of Medicine, University of Utah, Salt Lake City, UT (Froerer).
出版信息
J Am Acad Orthop Surg Glob Res Rev. 2022 Oct 24;6(10). doi: 10.5435/JAAOSGlobal-D-22-00206. eCollection 2022 Oct 1.
INTRODUCTION
Opioid overprescribing is a problem in orthopaedic surgery, with many patients having leftover opioid medications after surgery. The purpose of our study was to capture utilization patterns of opioids in pediatric patients undergoing orthopaedic sports medicine surgery, in addition to evaluating patient practices surrounding unutilized opioid medication. Our hypothesis was that there would be low utilization of opioids in this patient population and would in turn contribute to notable overprescribing of opioids and opioid retention in this population.
METHODS
Pediatric patients undergoing orthopaedic surgery for knee and hip pathology were prospectively enrolled. A survey was administered 14 days postoperatively, with questions centered on the patient-reported number of opioids prescribed, number of opioids used, number of days opioids were used, and incidences of leftover opioid medication and disposal of leftover medication. The magnitude of opioid overprescribing was calculated using the reported prescribed and reported used number of opioid pills. Linear regression was used to examine associations between opioids and NSAIDs prescribed.
RESULTS
One hundred fourteen patients reported a mean prescription of 12.0 ± 5.0 pills, with utilization of 4.4 ± 6.1 pills over 2.7 ± 5.1 days. Patients were prescribed 2.73 times the number of opioid pills required on average. One hundred patients (87.7%) reported having unused opioid medication after their surgery, with 71 (71.0%) reporting opioid retention. Regression results showed an association with opioids used and prescribed opioid amount (β = 0.582, R = 0.471, P < 0.001).
DISCUSSION
Overall, our study results help characterize the utilization patterns of opioid medications in the postsurgical pediatric sports orthopaedic population and suggest that orthopaedic surgeons may be able to provide smaller quantities of opioid pills for analgesia than is typically prescribed, which in turn may help reduce the amount of prescription opioid medications present in the community.
LEVEL OF EVIDENCE
Level IV.
引言
阿片类药物过量处方是矫形外科的一个问题，许多患者在手术后仍有剩余的阿片类药物。我们研究的目的是捕捉接受矫形运动医学手术的儿科患者中阿片类药物的使用模式，此外还评估了未使用的阿片类药物的患者使用情况。我们的假设是，在这一患者群体中，阿片类药物的使用率较低，这反过来又会导致该人群中阿片类药物的过度处方和阿片类药物的保留。
方法
前瞻性纳入接受膝关节和髋关节病变矫形手术的儿科患者。术后 14 天进行问卷调查，问题集中在患者报告的开处阿片类药物数量、使用的阿片类药物数量、使用阿片类药物的天数、剩余阿片类药物的发生率以及剩余药物的处置情况。使用报告的开处和使用的阿片类药物丸数来计算阿片类药物过度处方的程度。线性回归用于检查阿片类药物和 NSAIDs 处方之间的关联。
结果
114 名患者报告平均处方 12.0±5.0 片，使用 4.4±6.1 片，使用 2.7±5.1 天。患者平均开处的阿片类药物丸数是所需的 2.73 倍。100 名（87.7%）患者报告手术后有未使用的阿片类药物，其中 71 名（71.0%）报告阿片类药物保留。回归结果显示，阿片类药物的使用与开处阿片类药物的数量之间存在关联（β=0.582，R=0.471，P<0.001）。
讨论
总的来说，我们的研究结果有助于描述术后儿科运动矫形人群中阿片类药物的使用模式，并表明矫形外科医生可能能够提供比通常开处的数量更少的阿片类药物丸来进行镇痛，这反过来可能有助于减少社区中阿片类药物处方的数量。
证据水平
IV 级。
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