Zhang James, Limonard Aaron, Bradshaw Florence, Hussain Ishrat, Josipović Maša, Krkovic Matija
Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK.
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Br J Pain. 2024 Oct;18(5):433-443. doi: 10.1177/20494637241261013. Epub 2024 Jun 18.
Currently there are few opioid prescribing guidelines for orthopaedic fractures. Long-term post-surgical analgesia requirements, understandably, vary between orthopaedic cases. Our study aims to provide detailed information to clinicians and policy makers, on the opioid requirement associations for patients sustaining tibial fractures.
This study reviewed all patients sustaining an isolated tibial fracture at a major trauma centre that were operated on within 1 month of injury, from 2015 to 2022. The total opioid dosage used each month in morphine milligrams equivalents (MME) and the number of days opioids were used each month, within the first-year post-surgery were collected, representing the strength and coverage of opioid analgesia in the post-operative stage, respectively. We compared opioid strength and coverage requirements with types of definitive fracture fixations, location, fracture type and concurrent patient medical comorbidities to assess for any trends.
A total of 1814 patients sustaining a combined of 1970 fractures were included in the study. Tibial plateau fractures had the highest opioid strength and coverage requirements in each month and the entire year ( < .05). Across all fracture locations, Ex Fix frame showed higher opioid strength and coverage requirements compared to both IM nailing and plate ORIF. With regard to opioid coverage in the presence of specific comorbidities, only chronic kidney disease (quotient: 1.37, 95% Confidence interval [95%CI] = 1.19-1.55, = .002) and hypertension (quotient: 1.34, 95%CI = 1.14-1.53, = .009) showed significance at the 1-year overall level. For opioid strength, Chronic Kidney Disease (quotient: 1.72, 95%CI = 1.41-2.03 = .005) and COPD (quotient: 1.90, 95%CI = 1.44-2.36, = .014), show significance at the 1-year overall level.
Our study details opioid requirements post-surgery amongst tibial fractures with subgroup analysis assessing opioid needs amongst specific fracture locations, types, surgical techniques and medical comorbidities. This framework aids clinicians in anticipating rehabilitation and assists in risk stratifying patients at injury onset.
目前，针对骨科骨折的阿片类药物处方指南较少。可以理解的是，骨科手术后的长期镇痛需求因病例而异。我们的研究旨在为临床医生和政策制定者提供详细信息，说明胫骨骨折患者的阿片类药物需求关联情况。
本研究回顾了2015年至2022年期间在一家主要创伤中心接受治疗的所有单纯胫骨骨折患者，这些患者在受伤后1个月内接受了手术。收集了术后第一年每月使用的阿片类药物总剂量（以毫克吗啡当量[MME]表示）和每月使用阿片类药物的天数，分别代表术后阶段阿片类镇痛的强度和覆盖范围。我们将阿片类药物的强度和覆盖范围需求与确定性骨折固定的类型、位置、骨折类型以及患者并发的内科疾病进行比较，以评估是否存在任何趋势。
共有1814例患者发生了1970处骨折，纳入了本研究。胫骨平台骨折在每个月和全年的阿片类药物强度和覆盖范围需求最高（<.05）。在所有骨折部位中，与髓内钉固定和钢板切开复位内固定术相比，外固定架显示出更高的阿片类药物强度和覆盖范围需求。关于特定合并症患者的阿片类药物覆盖情况，仅慢性肾病（商数：1.37，95%置信区间[95%CI]=1.19-1.55，=.002）和高血压（商数：1.34，95%CI=1.14-1.53，=.009）在1年总体水平上具有统计学意义。对于阿片类药物强度，慢性肾病（商数：1.72，95%CI=1.41-2.03，=.005）和慢性阻塞性肺疾病（商数：1.90，95%CI=1.44-2.36，=.014）在1年总体水平上具有统计学意义。
我们的研究详细说明了胫骨骨折术后的阿片类药物需求，并进行了亚组分析，评估了特定骨折部位、类型、手术技术和内科合并症患者的阿片类药物需求。该框架有助于临床医生预测康复情况，并在受伤初期对患者进行风险分层。
