Division of Geriatric Medicine, Sinai Health, Toronto, ON, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Eur J Phys Rehabil Med. 2023 Apr;59(2):192-200. doi: 10.23736/S1973-9087.23.07650-5. Epub 2023 Feb 6.
While there is much evidence about pain management for orthopedic patients in the immediate perioperative setting, little is known about how opioids are used during inpatient rehabilitation, particularly in older adults. A safe upper limit of 50 mg oral morphine equivalents (OME) is frequently cited in guidelines.
The aim of this study was to characterize the dosing of opioids in an older adult population undergoing inpatient orthopedic rehabilitation (IOR).
Retrospective observational study.
Inpatient units at an academic rehabilitation hospital in Toronto, Canada.
All adults aged ≥50 years old admitted for orthopedic rehabilitation between November 2019 and June 2021 following acute care admissions for either a surgical or non-surgical orthopedic indication.
Participants were divided into groups of prior opioids users, new opioids users, and opioid non-users during IOR. Demographic, clinical, and medication administration data were collected through the electronic health record and manual chart review. Average daily opioid dose for the first seven days of each stay was characterized using OME. Linear regression was used to assess for variables independently associated with opioid dose.
A total of 643 patients undergoing orthopedic rehabilitation were included: 125 (19.4%) were prior opioid users, 416 (64.7%) were new opioid users, and 102 (15.9%) were non-users, with median age respectively of 72, 79, and 83. Median daily OME over the first week for prior users was 30.3 and for new users was 6.9. Opioid dose was inversely associated with age and admission for a non-surgical indication; it was positively associated with reported pain (as defined by day 3 pain score) and admission for knee replacement.
Opioids are frequently but heterogeneously used in older adults undergoing IOR. Median OME use in this cohort of older adults was substantially lower than the 50 OME threshold suggested in guidelines, particularly for new opioid users.
Older adults require much lower opioid doses than younger patients. Pain management in older orthopedic rehabilitation inpatients is distinct from the perioperative setting and deserves tailored guidance, with a focus on using the lowest effective dose.
虽然有很多关于骨科患者围手术期疼痛管理的证据，但对于在住院康复期间如何使用阿片类药物，特别是在老年人中，知之甚少。指南中经常提到安全的阿片类药物上限为 50 毫克口服吗啡当量（OME）。
本研究旨在描述在接受住院骨科康复（IOR）的老年人群中阿片类药物的剂量特征。
回顾性观察性研究。
加拿大多伦多一家学术康复医院的住院病房。
2019 年 11 月至 2021 年 6 月期间，因手术或非手术骨科指征在急性护理后入院的所有年龄≥50 岁的成年人，接受骨科康复治疗。
参与者被分为IOR 期间的先前使用阿片类药物者、新使用阿片类药物者和非使用者组。通过电子健康记录和手动图表审查收集人口统计学、临床和药物管理数据。使用 OME 描述每个住院期间前 7 天的平均每日阿片类药物剂量。线性回归用于评估与阿片类药物剂量独立相关的变量。
共纳入 643 名接受骨科康复治疗的患者：125 名（19.4%）为先前使用阿片类药物者，416 名（64.7%）为新使用阿片类药物者，102 名（15.9%）为非使用者，其年龄中位数分别为 72、79 和 83 岁。先前使用者第一周的平均每日 OME 中位数为 30.3，新使用者为 6.9。阿片类药物剂量与年龄和非手术适应证入院呈负相关；与报告的疼痛（定义为第 3 天疼痛评分）和膝关节置换术入院呈正相关。
在接受 IOR 的老年人中，阿片类药物经常但异质地使用。该老年人群的 OME 中位数使用量明显低于指南中 50 OME 阈值，特别是对于新使用阿片类药物者。
老年人需要的阿片类药物剂量远低于年轻患者。老年骨科康复住院患者的疼痛管理与围手术期不同，值得量身定制指导，重点是使用最低有效剂量。
