Nazzal Ehab M, Reddy Rajiv P, Haley Rebecca M, Wilson Jacob M, Lamplot Joseph D, Musahl Volker, Xerogeanes John W
University of Pittsburgh Medical Center Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, U.S.A.
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.
Arthrosc Sports Med Rehabil. 2023 Jul 28;5(5):100782. doi: 10.1016/j.asmr.2023.100782. eCollection 2023 Oct.
To characterize contemporary pain management strategies after anterior cruciate ligament reconstruction (ACLR) within the US and international orthopaedic community.
This was a cross-sectional survey-based study disseminated to a consortium of expert orthopaedic surgeons in the management of anterior cruciate ligament injuries. The survey was a 27-question, multiple choice-style questionnaire with question topics ranging from demographic characteristics and practice characteristics to surgeon-specific pain management strategies in the postoperative period after ACLR. Specific topics of interest included the use of preoperative opioid education and/or counseling sessions, implementation of standardized pain management regimens, use of pain tracking systems, and use of any adjunct non-narcotic analgesic modalities.
A total of 34 completed surveys were collected, representing a 73.9% response rate. Over 85% of respondents reported prescribing opioids as a standardized postoperative regimen after ACLR. Surgeons reported prescribing 5- to 10-mg doses, with the tablet count ranging anywhere from fewer than 10 tablets to more than 20 tablets, often instructing their patients to stop opioid use 2 to 4 days postoperatively. Prescribed dosages remained stable or decreased over the past 6 months with increased use of non-narcotic adjuncts. Only one-third of respondents reported using standardized preoperative opioid counseling, with even fewer discussing postoperative discontinuation protocols.
Over 85% of respondents prescribe opioids as a standardized postoperative regimen after ACLR, with only 15% providing non-narcotic pain regimens. However, prescribed dosages have remained stable or decreased over the past 6 months with increased use of non-narcotic adjuncts. Only one-third of respondents use standardized preoperative opioid counseling, with even fewer discussing postoperative discontinuation protocols.
The ongoing opioid epidemic has created an urgent need to identify the most effective pain management strategies after orthopaedic procedures, especially ACLR. This study provides important information about current pain management practices for patients who have undergone ACLR.
描述美国和国际骨科界在前交叉韧带重建（ACLR）术后的当代疼痛管理策略。
这是一项基于横断面调查的研究，调查对象为前交叉韧带损伤管理方面的骨科专家联盟。该调查是一份包含27个问题的多项选择题式问卷，问题主题涵盖人口统计学特征、执业特征以及ACLR术后外科医生特定的疼痛管理策略。感兴趣的具体主题包括术前阿片类药物教育和/或咨询课程的使用、标准化疼痛管理方案的实施、疼痛追踪系统的使用以及任何辅助非麻醉性镇痛方式的使用。
共收集到34份完整问卷，回复率为73.9%。超过85%的受访者表示将阿片类药物作为ACLR术后的标准化术后用药方案。外科医生报告的处方剂量为5至10毫克，药片数量从少于10片到超过20片不等，通常指示患者在术后2至4天停止使用阿片类药物。在过去6个月中，随着非麻醉性辅助药物使用的增加，处方剂量保持稳定或下降。只有三分之一的受访者报告使用标准化的术前阿片类药物咨询，讨论术后停药方案的更少。
超过85%的受访者将阿片类药物作为ACLR术后的标准化术后用药方案，只有15%提供非麻醉性疼痛方案。然而，在过去6个月中，随着非麻醉性辅助药物使用的增加，处方剂量保持稳定或下降。只有三分之一的受访者使用标准化的术前阿片类药物咨询，讨论术后停药方案的更少。
持续的阿片类药物流行迫切需要确定骨科手术后，尤其是ACLR术后最有效的疼痛管理策略。本研究为接受ACLR手术的患者提供了有关当前疼痛管理实践的重要信息。
