Castle Joshua P, Jildeh Toufic R, Abbas Muhammad J, Hennekes Mary E, Buckley Patrick J, Shabet Christina L, Cotter Daniel L, Moutzouros Vasilios
Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
Michigan State University College of Human Medicine, 4660 Hagadorn Rd Suite 420, East Lansing, MI, 48823, USA.
J Orthop. 2023 Apr 12;40:1-6. doi: 10.1016/j.jor.2023.04.002. eCollection 2023 Jun.
Despite established opioid-free protocols for postoperative analgesia after common orthopaedic sports procedures, many patients continue to request opioids postoperatively. The purpose of this study was to elucidate patient factors influencing preferences for opioid versus nonopioid postoperative analgesia.
Patients (age >/ = 15) without a history of a documented chronic pain disorder who were scheduled for one of ten sports procedure types from August 2020 to May 2021 were eligible for inclusion. Patients were excluded if undergoing revision surgery, had concomitant injuries, had opioids use >3 months preoperatively, or unable to read English. Recruitment ended after 100 patients enrolled. At the patients' preoperative visit, patients were administered a written survey assessing pain medication preferences. Participants completed the Opioid Risk Tool survey, as well as Visual Analog Scale and Patient-Reported Outcome Measurement Information System surveys.
One hundred patients participated in the study. Forty-two patients preferred opioids versus 58 patients preferring nonopioid postoperative analgesia. Patients preferring opiates were more likely to have had previous surgery (90.2% vs. 69.6%, p = 0.023) with post-operative pain managed with opiates (87.5% vs 55.4%, p = 0.003), higher preoperative Visual Analog Scale score (6±3.5 vs. 3±2, p < 0.001), reported post-operative pain as a reason for opioids preference (88.1% vs 20.0%, p < 0.001), and were less concerned about addiction (4.8% vs. 45.5%, p < 0.001) and side effects (11.9% vs. 52.7%, p < 0.001). For every unit increase in Visual Analog Scale score, the odds of preferring opioid pain control increased 1.41 times.
Patients with a history of prior surgery utilizing opioid pain control, higher Visual Analog Scale scores preoperatively, and concern for inadequately managed postoperative pain were more likely to prefer opioid pain control following common orthopaedic sports procedures. Patients may benefit from increased preoperative education about opioid risks and the role of multimodal pain management regimens.
尽管在常见的骨科运动手术后已经制定了无阿片类药物的术后镇痛方案，但许多患者术后仍继续要求使用阿片类药物。本研究的目的是阐明影响患者对阿片类与非阿片类术后镇痛偏好的因素。
纳入2020年8月至2021年5月计划进行十种运动手术类型之一、无慢性疼痛疾病记录史且年龄≥15岁的患者。如果患者正在接受翻修手术、有合并伤、术前使用阿片类药物超过3个月或无法阅读英文，则排除在外。在100名患者入组后结束招募。在患者术前访视时，给患者发放一份评估疼痛药物偏好的书面调查问卷。参与者完成阿片类药物风险工具调查，以及视觉模拟量表和患者报告结局测量信息系统调查。
100名患者参与了研究。42名患者更喜欢阿片类药物，而58名患者更喜欢非阿片类术后镇痛。更喜欢阿片类药物的患者更有可能曾接受过手术（90.2%对69.6%，p = 0.023），且术后疼痛用阿片类药物控制（87.5%对55.4%，p = 0.003），术前视觉模拟量表评分更高（6±3.5对3±2，p < 0.001），将术后疼痛报告为偏好阿片类药物的原因（88.1%对20.0%，p < 0.001），并且对成瘾（4.8%对45.5%，p < 0.001）和副作用（11.9%对52.7%，p < 0.001）的担忧较少。视觉模拟量表评分每增加一个单位，偏好阿片类药物镇痛的几率增加1.41倍。
有使用阿片类药物控制疼痛的既往手术史、术前视觉模拟量表评分较高且担心术后疼痛管理不当的患者，在常见的骨科运动手术后更有可能偏好阿片类药物镇痛。患者可能会从增加术前关于阿片类药物风险和多模式疼痛管理方案作用的教育中受益。
