Study Centre in Emergency Medicine (Daoust, Paquet, Huard, Lessard, Cournoyer), Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Nord-de-l'Île de-Montréal, Sacré-Coeur Hospital; Département de médecine de famille et médecine d'urgence (Daoust, Huard, Lessard, Cournoyer), Faculté de médecine, Université de Montréal, Montréal, Que.; Département de médecine de famille et de médecine d'urgence (Émond), Faculté de Médecine, Université Laval; Département d'urgence du CHU-Québec (Émond), Québec, Que.; Department of Emergency Medicine (Iseppon), Hôpital Maisonneuve-Rosemont; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île-de-Montréal) (Williamson, Lavigne); Faculté de Pharmacie (Williamson), Université de Montréal, Montréal, Que.; Division of Emergency Medicine (Yan), Department of Medicine, Western University, London Health Sciences Centre, London, Ont.; Department of Emergency Medicine (Perry), University of Ottawa, Ottawa, Ont.; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal, Montréal, Que.; Department of Emergency Services and Scientist (Lee), Clinical Epidemiology Unit, Sunnybrook Health Sciences; Schwartz/Reisman Emergency Medicine Institute (Lee), Mount Sinai Hospital, Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.
CMAJ. 2024 Jul 14;196(25):E866-E874. doi: 10.1503/cmaj.231640.
Unused opioid prescriptions can be a driver of opioid misuse. Our objective was to determine the optimal quantity of opioids to prescribe to patients with acute pain at emergency department discharge, in order to meet their analgesic needs while limiting the amount of unused opioids.
In a prospective, multicentre cohort study, we included consecutive patients aged 18 years and older with an acute pain condition present for less than 2 weeks who were discharged from emergency department with an opioid prescription. Participants completed a pain medication diary for real-time recording of quantity, doses, and names of all analgesics consumed during a 14-day follow-up period.
We included 2240 participants, who had a mean age of 51 years; 48% were female. Over 14 days, participants consumed a median of 5 (quartiles, 1-14) morphine 5 mg tablet equivalents, with significant variation across pain conditions ( < 0.001). Most opioid tablets prescribed (63%) were unused. To meet the opioid need of 80% of patients for 2 weeks, we found that those experiencing renal colic or abdominal pain required fewer opioid tablets (8 morphine 5 mg tablet equivalents) than patients who had fractures (24 tablets), back pain (21 tablets), neck pain (17 tablets), or other musculoskeletal pain (16 tablets).
Two-thirds of opioid tablets prescribed at emergency department discharge for acute pain were unused, whereas opioid requirements varied significantly based on the cause of acute pain. Smaller, cause-specific opioid prescriptions could provide adequate pain management while reducing the risk of opioid misuse.
ClinicalTrials.gov, no. NCT03953534.
未使用的阿片类药物处方可能是阿片类药物滥用的一个驱动因素。我们的目的是确定在急诊科出院时为急性疼痛患者开具的阿片类药物的最佳剂量，以满足他们的镇痛需求，同时限制未使用的阿片类药物的数量。
在一项前瞻性、多中心队列研究中，我们纳入了 2240 名年龄在 18 岁及以上、疼痛持续时间少于 2 周且因急性疼痛从急诊科出院并开具阿片类药物处方的连续患者。参与者在 14 天的随访期间完成了一份疼痛药物日记，实时记录所有镇痛药物的用量、剂量和名称。
我们纳入了 2240 名参与者，平均年龄为 51 岁；48%为女性。在 14 天内，参与者中位数消耗了 5（四分位距，1-14）吗啡 5mg 片剂等效物，不同疼痛状况之间存在显著差异（<0.001）。大多数开出的阿片类药物片剂（63%）未被使用。为了满足 80%患者 2 周的阿片类药物需求，我们发现经历肾绞痛或腹痛的患者需要的阿片类药物片剂（8 片吗啡 5mg 片剂等效物）比骨折患者（24 片）、背痛患者（21 片）、颈痛患者（17 片）或其他肌肉骨骼疼痛患者（16 片）少。
急诊科为急性疼痛开出的阿片类药物处方中，有三分之二未被使用，而阿片类药物的需求因急性疼痛的原因而有显著差异。较小的、针对病因的阿片类药物处方可以提供足够的疼痛管理，同时降低阿片类药物滥用的风险。
ClinicalTrials.gov，编号 NCT03953534。
