Young Porter F, Roberts Christopher, Shi Glenn G, Heckman Michael G, White Launia, Clendenen Steven, Wilke Benjamin
Orthopedic Surgery, University of Florida, Jacksonville, USA.
Orthopedic Surgery, Mayo Clinic, Jacksonville, USA.
Cureus. 2024 Mar 14;16(3):e56150. doi: 10.7759/cureus.56150. eCollection 2024 Mar.
Orthopedic surgeons are the third highest prescribers of narcotics. Previous work demonstrated that surgeons prescribe three times the narcotics required, and most patients do not properly dispose of leftover medication following surgery. This has prompted the creation of multimodal pain regimens to reduce reliance on narcotics. It is unknown if these pathways can effectively eliminate opioids following total knee arthroplasty (TKA). Our purpose was to evaluate a multimodal regimen without schedule II narcotics following TKA, in a randomized, blinded fashion. We hypothesized that there would be no difference in pain scores between groups.
A total of 43 narcotic-naïve patients participated in a randomized, double-blinded, placebo-controlled trial. Postoperative protocols were identical between cohorts, except for the study medication. The narcotic group received an encapsulated 5 mg oxycodone, whereas the control group received an encapsulated placebo. Perioperative outcomes were compared with routine statistical analysis.
Four patients withdrew early secondary to pain: three in the placebo group and one in the narcotic group (p=1.00). We found no difference in hospital length of stay (p=0.09) or pain scores at all time points between cohorts (all p>0.05). There was a higher proportion of patients using a narcotic in the opioid treatment arm at day 30 (40% vs. 21.4%, p=0.29) and day 60 (20% vs. 7.1%, p=0.32), although this was not statistically significant.
A multimodal regimen without schedule II narcotics demonstrates equivalent pain scores and may reduce the risk of long-term opioid dependence following TKA.
骨科医生是麻醉药品的第三大处方者。先前的研究表明，外科医生开出的麻醉药品是所需量的三倍，而且大多数患者在术后没有妥善处理剩余药物。这促使人们制定多模式疼痛治疗方案以减少对麻醉药品的依赖。目前尚不清楚这些方案在全膝关节置换术（TKA）后能否有效消除阿片类药物。我们的目的是以随机、盲法的方式评估TKA后不使用II类麻醉药品的多模式治疗方案。我们假设两组之间的疼痛评分没有差异。
共有43名未使用过麻醉药品的患者参与了一项随机、双盲、安慰剂对照试验。除研究药物外，各队列的术后方案相同。麻醉药品组接受一粒5毫克的羟考酮胶囊，而对照组接受一粒安慰剂胶囊。采用常规统计分析比较围手术期结果。
4名患者因疼痛提前退出：安慰剂组3名，麻醉药品组1名（p = 1.00）。我们发现两组之间的住院时间（p = 0.09）或各时间点的疼痛评分均无差异（所有p>0.05）。在第30天（40%对21.4%，p = 0.29）和第60天（20%对7.1%，p = 0.32），阿片类药物治疗组使用麻醉药品的患者比例较高，尽管这无统计学意义。
不使用II类麻醉药品的多模式治疗方案显示出相当的疼痛评分，并且可能降低TKA后长期阿片类药物依赖的风险。
