Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan.
Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan.
J Arthroplasty. 2024 Aug;39(8):2130-2136.e7. doi: 10.1016/j.arth.2024.01.063. Epub 2024 Feb 8.
Pain is challenging after recovery from total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures, and patients often receive prescription opioids. However, opioid consumption by patients remains unclear, and unused opioids may lead to risks including misuse and diversion. The objective of this systematic review and meta-analysis was to compare prescription size versus patient-reported consumption of opioids after discharge following TKA and THA.
PubMed and Embase were systematically searched for publications published between 2015 and 2022 on patient-reported consumption of opioids after TKA and THA. The primary outcome was opioid use in oxycodone 5-mg equivalents. Team members independently reviewed studies for screening, inclusion, data extraction, and risk of bias.
Among the 17 included studies (15 TKA and 11 THA), discharge opioid prescribing exceeded consumption for both TKA (88.4 versus 65.0 pills at 6 weeks) and THA (64.0 versus 29.8 pills at 12 weeks). For both TKA and THA, the range of opioids prescribed varied significantly, by 1.6-fold for TKA and 2.8-fold for THA. Most studies reported pain outcomes (89%) and the use of nonopioid medications (72%). Of the 4 studies offering prescribing recommendations, the amounts ranged from 50 to 104 pills for TKA and 30 to 45 pills for THA.
Opioid prescribing exceeds the amount consumed following TKA and THA. These findings serve as a call to action to tailor prescribing guidelines to how much patients actually consume while emphasizing the use of nonopioid medications to better optimize recovery from surgery.
全膝关节置换术（TKA）和全髋关节置换术（THA）术后疼痛具有挑战性，患者通常会接受处方阿片类药物。然而，患者的阿片类药物消耗情况仍不清楚，未使用的阿片类药物可能会导致滥用和转移等风险。本系统评价和荟萃分析的目的是比较 TKA 和 THA 术后出院后处方剂量与患者报告的阿片类药物消耗情况。
系统检索了 2015 年至 2022 年期间发表的关于 TKA 和 THA 后患者报告的阿片类药物消耗情况的 PubMed 和 Embase 出版物。主要结局是使用羟考酮 5mg 等效物的阿片类药物使用情况。研究小组成员独立审查了筛选、纳入、数据提取和偏倚风险的研究。
在纳入的 17 项研究中（15 项 TKA 和 11 项 THA），TKA（6 周时 88.4 片 vs. 65.0 片）和 THA（12 周时 64.0 片 vs. 29.8 片）的出院阿片类药物处方均超过消耗。对于 TKA 和 THA，处方的阿片类药物范围差异很大，TKA 为 1.6 倍，THA 为 2.8 倍。大多数研究报告了疼痛结局（89%）和非阿片类药物的使用（72%）。在提供处方建议的 4 项研究中，TKA 的用量范围为 50-104 片，THA 的用量范围为 30-45 片。
TKA 和 THA 术后阿片类药物的开具量超过了消耗量。这些发现呼吁制定处方指南，使其与患者实际消耗的量相匹配，同时强调使用非阿片类药物，以更好地优化手术恢复。
