Bilek Aaron J, Cullen Stephanie, Tan Carolyn M, Li Qixuan, Huszti Ella, Norman Richard E
Division of Geriatric Medicine, Sinai Health, Toronto, Canada.
Faculty of Medicine, University of Toronto, Toronto, Canada.
PM R. 2024 Dec;16(12):1324-1333. doi: 10.1002/pmrj.13205. Epub 2024 Jun 7.
Multimodal analgesia (MMA) combines opioids with nonopioid analgesics (NOAs) to mitigate opioid-related adverse events and development of opioid use disorders. Although MMA has become the standard for orthopedic perioperative pain management, guidance is less clear for the approximately 15% of patients who go on to require inpatient orthopedic rehabilitation (IOR) postoperatively. The IOR population tends to be older and frailer and hence likely more vulnerable to adverse events. Little research has been done to shed light on how NOAs are used in this population.
To characterize NOA prescribing in older versus younger adults during IOR admissions and to determine predictors of NOA prescribing in an older IOR population.
Retrospective case-control study.
Two IOR wards at an academic rehabilitation hospital in Toronto, Canada.
All patients aged ≥50 years admitted for an orthopedic indication between November 2019 and June 2021; the patients aged <65 group was included for comparative characterization of NOA prescribing versus older peers.
Not applicable.
Medication use and adverse events, pain, and rehabilitation outcomes such as the Functional Independence Measure, discharge destination, and length of stay.
A total of 643 patient encounters were included; 48.2% used NOA. Age (odds ratio [OR]: 0.97; confidence interval [CI]: 0.95-0.99, p < .001) and prior NOA use (OR: 3.15; CI: 2.0-4.9, p < .001) were associated with NOA prescribing. Other positively associated factors included body mass index, psychiatric history, elective surgery, and admission from a specific referring hospital. Adverse events between NOA users and nonusers were similar.
NOA prescribing is heterogeneous and declines with age in IOR. This points to an opportunity to explore integrating NOA into opioid-sparing MMA protocols tailored to older IOR patients, along with further study of the safety and benefit of these regimens.
多模式镇痛（MMA）将阿片类药物与非阿片类镇痛药（NOA）联合使用，以减轻与阿片类药物相关的不良事件和阿片类药物使用障碍的发生。尽管MMA已成为骨科围手术期疼痛管理的标准，但对于术后约15%需要住院骨科康复（IOR）的患者，相关指导尚不够明确。IOR患者往往年龄较大且身体较为虚弱，因此可能更容易发生不良事件。关于NOA在该人群中的使用情况，目前的研究较少。
描述IOR住院期间老年人与年轻人NOA的处方情况，并确定老年IOR人群中NOA处方的预测因素。
回顾性病例对照研究。
加拿大多伦多一家学术康复医院的两个IOR病房。
2019年11月至2021年6月期间因骨科适应症入院的所有年龄≥50岁的患者；纳入年龄<65岁的患者组，以比较NOA处方与老年同龄人之间的差异。
不适用。
药物使用、不良事件、疼痛以及康复结局，如功能独立性测量、出院目的地和住院时间。
共纳入643例患者；48.2%使用了NOA。年龄（优势比[OR]：0.97；置信区间[CI]：0.95-0.99，p<0.001）和既往NOA使用情况（OR：3.15；CI：2.0-4.9，p<0.001）与NOA处方相关。其他正相关因素包括体重指数、精神病史、择期手术以及来自特定转诊医院的入院情况。NOA使用者和非使用者之间的不良事件相似。
IOR中NOA的处方情况存在异质性，且随年龄增长而减少。这表明有机会探索将NOA纳入针对老年IOR患者的阿片类药物节省型MMA方案，并进一步研究这些方案的安全性和益处。
