Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA.
Eur J Orthop Surg Traumatol. 2024 Apr;34(3):1543-1549. doi: 10.1007/s00590-024-03836-7. Epub 2024 Jan 27.
The opioid epidemic has changed practice, though there remains a paucity of data regarding prescribing habits and pain control following outpatient hand surgery. We sought to evaluate patient-related predictors of adequate postoperative pain control.
A retrospective review was performed of a single-center prospectively collected database of elective outpatient surgery on the elbow, forearm, wrist, and/or hand. Patients were asked to complete preoperative and postoperative questionnaires to capture their perception of anticipated pain levels, expected prescription quantity/duration, additional medications used, and overall pain satisfaction. Patient demographics collected included, sex, age, race, tobacco use, and recreational drug use. Further, the questionnaire included the Brief Resilience Score (BRS), EuroQol 5-dimension health-related QOL measure (EQ-5D), and an assessment of patient-reported limitations secondary to their pain.
Ninety-six patients completed the pre/postoperative questionnaires and were eligible for analysis. Of these patients, 80% reported adequate pain control. The sex, age, and race of those who reported adequate pain control and inadequate control were not significantly different. BRS scores were not found to be significantly different between groups, although EQ-5D QOL scores were significantly lower in the inadequately controlled group. Tobacco use was more prevalent in the inadequately controlled group. Marijuana use and the presence of a chronic pain diagnosis were not significantly different between groups.
Preoperative self-reported quality of life measures and tobacco use appear to have significant effects on postoperative opioid use, suggesting further areas of optimization which may ensure patients are safe and minimize the number of opioid pills required.
阿片类药物泛滥改变了实践，尽管有关门诊手部手术后的处方习惯和疼痛控制的数据仍然很少。我们试图评估与患者相关的预测因素，以确定术后疼痛控制是否充分。
对单中心前瞻性收集的肘部、前臂、腕部和/或手部择期门诊手术数据库进行回顾性分析。患者被要求在术前和术后完成问卷调查，以了解他们对预期疼痛水平、预期处方数量/持续时间、使用的其他药物以及整体疼痛满意度的感知。收集的患者人口统计学数据包括性别、年龄、种族、吸烟和娱乐性药物使用情况。此外，问卷还包括简要韧性评分（BRS）、欧洲五维健康相关生活质量量表（EQ-5D）以及对因疼痛而导致的患者报告的局限性的评估。
96 名患者完成了术前/术后问卷调查，符合分析条件。在这些患者中，80%报告疼痛得到充分控制。报告疼痛得到充分控制和控制不足的患者的性别、年龄和种族没有显著差异。两组之间的 BRS 评分没有显著差异，尽管 EQ-5D 生活质量评分在控制不足组中显著较低。在控制不足组中，吸烟更为普遍。大麻使用和慢性疼痛诊断的存在在两组之间没有显著差异。
术前自我报告的生活质量测量和吸烟似乎对术后阿片类药物的使用有显著影响，这表明有进一步的优化空间，以确保患者安全并尽量减少所需的阿片类药物剂量。
