Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia.
Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Anaesthesia. 2024 Nov;79(11):1180-1190. doi: 10.1111/anae.16390. Epub 2024 Jul 31.
Opioid analgesic use before total hip or knee arthroplasty has been associated with worse postoperative outcomes. This pilot study aimed to examine the feasibility of a telehealth-based pharmacist-partnered opioid tapering intervention before elective primary hip or knee arthroplasty and its potential effectiveness compared with usual care.
This study was conducted at seven hospitals in New South Wales, Australia. Eligible patients were those aged ≥ 18 years, scheduled to undergo primary hip or knee arthroplasty for osteoarthritis and taking opioid analgesics pre-operatively. The intervention group participated in an opioid tapering telehealth service, a partnership between a pharmacist and general practitioner, for 3 months pre-operatively up to the day of surgery, while the control group received usual care. The primary outcomes of the study were to investigate the feasibility of the intervention (i.e. adherence to treatment) and potential effectiveness in decreasing baseline daily opioid dose by > 50% before surgery.
Between December 2021 and June 2023, 70 patients were recruited and assigned randomly to the intervention group (n = 35) or control group (n = 35). Baseline characteristics were similar between groups. Thirty patients in each group completed their allocated treatment. All patients allocated to the intervention group completed at least one appointment with a pharmacist, with the median (IQR [range]) being 2 (1-4 [1-6]) appointments. The number of patients who successfully decreased their baseline daily opioid dose by ≥ 50% before surgery was 27/30 in the intervention group compared with 5/30 in the usual care group (p < 0.001).
The findings of this pilot study support the feasibility of a telehealth-delivered, pharmacist-partnered opioid tapering service for patients scheduled for primary hip or knee arthroplasty. A broader multicentre study to examine the effectiveness of this intervention on clinical outcomes is warranted.
全髋关节或全膝关节置换术前使用阿片类镇痛药与术后结局较差有关。本试点研究旨在检验在择期初次髋关节或膝关节置换术前，基于远程医疗的药师-全科医生合作阿片类药物逐渐减量干预的可行性，并与常规护理进行比较。
该研究在澳大利亚新南威尔士州的 7 家医院进行。符合条件的患者为年龄≥18 岁、因骨关节炎计划接受初次髋关节或膝关节置换术且术前正在服用阿片类镇痛药的患者。干预组在术前 3 个月至手术当天参与了一项阿片类药物逐渐减量的远程医疗服务，这是药师与全科医生的合作，而对照组则接受常规护理。该研究的主要结局是调查干预措施的可行性（即治疗的依从性）以及在手术前将基线每日阿片类药物剂量减少>50%的潜在效果。
2021 年 12 月至 2023 年 6 月，共招募了 70 名患者并随机分配到干预组（n=35）或对照组（n=35）。两组患者的基线特征相似。每组各有 30 名患者完成了分配的治疗。所有分配到干预组的患者都至少与一名药剂师进行了一次预约，中位数（IQR[范围]（1-4[1-6]）次预约。在干预组中，有 27/30 名患者成功地将基线每日阿片类药物剂量减少≥50%，而在常规护理组中只有 5/30 名患者（p<0.001）。
这项试点研究的结果支持为计划接受初次髋关节或膝关节置换术的患者提供远程医疗提供的药师-全科医生合作的阿片类药物逐渐减量服务的可行性。有必要进行一项更广泛的多中心研究，以检验这种干预对临床结局的有效性。
