Liddy Nicole, Kamdar Parth M, Quintana Julio O, Talamo Michael, Vadasdi Katherine B, Greene Timothy, Kowalsky Marc S, Delos Demetrios, Sethi Paul M
New York Medical College, Valhalla, New York, U.S.A.
Orthopaedic & Neurosurgery Specialists (ONS) Foundation for Clinical Research and Education, Greenwich, Connecticut, U.S.A.
Arthrosc Sports Med Rehabil. 2023 Feb 20;5(2):e415-e421. doi: 10.1016/j.asmr.2023.01.009. eCollection 2023 Apr.
To prospectively determine opioid consumption in patients undergoing anterior cruciate ligament (ACL) repair and reconstruction and to develop evidence-based prescription guidelines following ACL surgery.
This multicenter prospective study enrolled patients undergoing ACL reconstruction and repair. Subject demographics and opioid prescriptions were recorded at enrollment. All patients were given education on opiate use and followed the same perioperative, multimodal analgesic regimen. Following surgery, patients were given postoperative "pain journals" to document visual analog scale pain scores and daily opioid consumption for the first 7 postoperative days and on postoperative visit at 14 days.
In total, 50 patients were included in this analysis between the ages of 14 and 65 years. Patients were prescribed a median of 15 oxycodone 5-mg pills and consumed a median of 2 pill postoperatively (range 0-19 pills). 38% of patients consumed 0 opioid pills, 74% of patients consumed ≤5 opioid pills, and 96% of patients consumed ≤15 opioid pills. Patients reported a mean daily visual analog scale value of 2.8 of 10; mean satisfaction with pain management was high at 4.1/5 on a Likert satisfaction score. Overall, patients consumed a mean 34% of their opioid prescriptions, leaving 436 opioid pills not consumed.
This study suggests that current expert panels may be recommending an excessive volume of opioids. Based on our findings, we recommend that patients be prescribed no more than 15 Oxycodone 5-mg tablets following ACL surgery. Despite this lower volume prescription, mean pain scores remained below 3 of 10, patient satisfaction with pain control remained high, and 66% of opiate medication prescribed was not used.
II, prospective prognostic cohort investigation.
前瞻性地确定前交叉韧带（ACL）修复和重建患者的阿片类药物消耗量，并制定基于证据的ACL手术后处方指南。
这项多中心前瞻性研究纳入了接受ACL重建和修复的患者。在入组时记录受试者的人口统计学资料和阿片类药物处方。所有患者均接受了阿片类药物使用教育，并遵循相同的围手术期多模式镇痛方案。手术后，患者被给予术后“疼痛日记”，以记录术后前7天以及术后14天复诊时的视觉模拟评分疼痛分数和每日阿片类药物消耗量。
本分析共纳入50例年龄在14至65岁之间的患者。患者的羟考酮5毫克片剂处方中位数为15片，术后消耗量中位数为2片（范围为0至19片）。38%的患者未服用阿片类药物，74%的患者服用≤5片阿片类药物，96%的患者服用≤15片阿片类药物。患者报告的每日视觉模拟评分平均值为10分中的2.8分；在李克特满意度评分中，患者对疼痛管理的平均满意度较高，为4.1/5。总体而言，患者消耗了其阿片类药物处方的平均34%，剩余436片阿片类药物未使用。
本研究表明，当前的专家小组可能推荐了过量的阿片类药物。基于我们的研究结果，我们建议ACL手术后患者的羟考酮处方不超过15片5毫克片剂。尽管处方量较低，但平均疼痛评分仍低于10分中的3分，患者对疼痛控制的满意度仍然较高，并且所开阿片类药物中有66%未被使用。
II，前瞻性预后队列研究。
