Hearty Thomas M, Butler Paul, Anderson John, Bohay Donald
St. Joseph Mercy Ann Arbor, Ann Arbor, MI, USA.
DMOS Orthopaedic Centers, Ankeny, IA, USA.
Foot Ankle Orthop. 2023 Aug 14;8(3):24730114231195057. doi: 10.1177/24730114231195057. eCollection 2023 Jul.
The misuse and abuse of opioid pain medications have become a public health crisis. Because orthopedic surgeons are the third highest prescribers of opioids, understanding their postoperative pain medication prescribing practices is key to solving the opioid crisis. To this end, we conducted a study of the variability in orthopedic foot and ankle surgery postoperative opioid prescribing practice patterns.
Three hundred fifty orthopedic foot and ankle surgeons were contacted; respondents completed a survey with 4 common patient scenarios and surgical procedures followed by questions regarding typical postoperative pain medication prescriptions. The scenarios ranged from minimally painful procedures to those that would be expected to be significantly more painful. Summaries were calculated as percentages and chi-square or Fisher exact tests were used to compare survey responses between groups stratified by years in practice and type of practice.
Sixty-four surgeons responded to the survey (92.8% male), 31% were in practice less than 5 years, 34% 6 to 15 years and 34% more than 15 years. For each scenario, there was variation in the type of pain medication prescribed (: 17% 5 mg hydrocodone, 22% 10 mg hydrocodone, 52% oxycodone, and 3% oxycodone sustained release [SR]; : 15% 5 mg hydrocodone, 13% 10 mg hydrocodone, 58% oxycodone, and 9% oxycodone SR; : 11% 5 mg hydrocodone, 13% 10 mg hydrocodone, 56% oxycodone, and 14.1% oxycodone SR; : 3% 5 mg hydrocodone, 5% 10 mg hydrocodone, 44% oxycodone, and 45% oxycodone SR) and the number of pills dispensed. Use of multimodal pain management was variable but most physicians use regional nerve blocks for each scenario (76%, 87%, 69%, 94%). Less experienced surgeons (less than 5 years in practice) supplement with tramadol more for scenario 1 ( = .034) as well as use regional nerve blocks for scenario 2 ( = .039) more than experienced surgeons (more than 15 years in practice).
It is evident that variation exists in narcotic prescription practices for postoperative pain management by orthopedic foot and ankle surgeons. With new AAOS guidelines, it is important to try to create some standardization in opioid prescription protocols.
阿片类止痛药物的误用和滥用已成为一场公共卫生危机。由于骨科医生是阿片类药物的第三大处方开具者，了解他们术后疼痛药物的处方习惯是解决阿片类药物危机的关键。为此，我们开展了一项关于骨科足踝手术术后阿片类药物处方实践模式变异性的研究。
我们联系了350名骨科足踝外科医生；受访者完成了一项包含4种常见患者情况和手术操作的调查，随后是关于典型术后疼痛药物处方的问题。这些情况从疼痛轻微的手术到预计会明显更疼痛的手术不等。汇总数据以百分比计算，并使用卡方检验或Fisher精确检验来比较按执业年限和执业类型分层的组间调查回复。
64名外科医生回复了调查（92.8%为男性），31%的医生执业年限少于5年，34%为6至15年，34%超过15年。对于每种情况，所开疼痛药物的类型存在差异（：17%为5毫克氢可酮，22%为10毫克氢可酮，52%为羟考酮，3%为羟考酮缓释剂[SR]；：15%为5毫克氢可酮，13%为10毫克氢可酮，58%为羟考酮，9%为羟考酮SR；：[此处原文缺失部分内容]；：3%为5毫克氢可酮，5%为10毫克氢可酮，44%为羟考酮，45%为羟考酮SR）以及所配发药丸的数量。多模式疼痛管理的使用情况各不相同，但大多数医生在每种情况下都使用区域神经阻滞（分别为76%、87%、69%、94%）。经验不足的外科医生（执业年限少于5年）在情况1中更多地使用曲马多作为补充（P = 0.034），并且在情况2中使用区域神经阻滞的比例（P = 0.039）高于经验丰富的外科医生（执业年限超过15年）。
显然，骨科足踝外科医生在术后疼痛管理中的麻醉处方实践存在差异。鉴于美国骨科医师学会的新指南，在阿片类药物处方方案中努力实现一些标准化非常重要。
