Boggs Lauryn J, Patel Ishan, Holyszko Melina, Little Bryan E, Darwiche Hussein F, Vaidya Rahul
Department of Orthopedic Surgery, Wayne State University School of Medicine, 540 E. Canfield Ave., Detroit, MI, 48201, USA.
Department of Orthopaedics, Detroit Medical Center, 311 Mack Ave 5Th Floor, Detroit, MI, 48201, USA.
Arthroplasty. 2024 Nov 1;6(1):55. doi: 10.1186/s42836-024-00276-w.
Total joint arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis, but postoperative pain has been poorly managed. The purpose of this study was to (1) assess how much narcotic medication was prescribed after TJA; (2) assess if patients were satisfied with their pain management; (3) compare these same data between total hip arthroplasty (THA)/total knee arthroplasty (TKA); (4) compare these same data between preoperative opioid users/opioid-naïve patients.
An IRB-approved prospective study was conducted at a US academic joint replacement practice. Patients were evaluated by an independent observer at three weeks, three months, and six months postoperatively using the Detroit Interventional Pain Assessment (DIPA) scale. Patients verbally rated their pain with their current medication regimen as 0 (no pain), 1 (tolerable pain), or 2 (intolerable pain) on the DIPA scale. Narcotic usage was verified by the Michigan Automated Prescription System (MAPS). Patients were divided into THA, TKA, previously on opioids, and opioid-naïve groups. Provider efficiency scores reflected pain management satisfaction and were calculated as the percentage of patients reporting no pain or tolerable pain.
Out of 200 patients, the percentage of patients using narcotics and their daily usage (MMEs) significantly decreased from 75.5% (27.5 MMEs) at three weeks to 42.9% (5.3 MMEs) at six months (P < 0.001). In 80% of patients, narcotics taken at six months were prescribed by outside providers. Significantly fewer patients used narcotics at six months for THA (15.4%) compared to TKA (52.7%) (P < 0.021). There was a significant difference in daily narcotic usage between patients who took narcotics preoperatively (22.9 MMEs) and opioid-naïve ones (13.4 MMEs) (P < 0.001). Provider efficiency scores were best at three weeks (76.6%) and three months (70%) but declined at six months (57.2%).
Narcotic tapering practices were observed as postoperative daily narcotic intake decreased across six months. However, outside providers prescribed 80% of narcotics at six months, necessitating a better-coordinated practice with surgeons. Patients taking preoperative narcotics experienced higher daily MME requirements than their opioid-naïve counterparts. In terms of the percentage of patients on narcotics, THA is a better procedure for tapering patients off narcotics by six months.
全关节置换术（TJA）是终末期骨关节炎的有效治疗方法，但术后疼痛管理效果不佳。本研究的目的是：（1）评估TJA术后开具了多少麻醉药物；（2）评估患者对疼痛管理是否满意；（3）比较全髋关节置换术（THA）/全膝关节置换术（TKA）之间的相同数据；（4）比较术前使用阿片类药物的患者/未使用过阿片类药物的患者之间的相同数据。
在美国一家学术性关节置换机构进行了一项经机构审查委员会批准的前瞻性研究。术后三周、三个月和六个月，由一名独立观察员使用底特律介入性疼痛评估（DIPA）量表对患者进行评估。患者根据当前用药方案，在DIPA量表上对疼痛进行口头评分，0分为无疼痛，1分为可忍受疼痛，2分为无法忍受疼痛。通过密歇根自动处方系统（MAPS）核实麻醉药物的使用情况。患者被分为THA组、TKA组、既往使用过阿片类药物组和未使用过阿片类药物组。医疗服务提供者效率得分反映疼痛管理满意度，计算方法为报告无疼痛或可忍受疼痛的患者百分比。
在200名患者中，使用麻醉药物的患者百分比及其每日使用量（吗啡毫克当量）从术后三周的75.5%（27.5吗啡毫克当量）显著降至六个月时的42.9%（5.3吗啡毫克当量）（P<0.001）。在80%的患者中，六个月时服用的麻醉药物是由外部医疗服务提供者开具的。与TKA组（52.7%）相比，THA组在六个月时使用麻醉药物的患者明显较少（15.4%）（P<0.021）。术前服用麻醉药物的患者（22.9吗啡毫克当量）与未使用过阿片类药物的患者（13.4吗啡毫克当量）之间的每日麻醉药物使用量存在显著差异（P<0.001）。医疗服务提供者效率得分在术后三周（76.6%）和三个月（70%）时最佳，但在六个月时下降（57.2%）。
观察到随着术后六个月内每日麻醉药物摄入量的减少，存在逐渐减少麻醉药物用量的做法。然而，在六个月时，80%的麻醉药物是由外部医疗服务提供者开具的，因此需要与外科医生进行更好的协调。术前服用麻醉药物的患者比未使用过阿片类药物的患者每日所需吗啡毫克当量更高。就服用麻醉药物的患者百分比而言，THA手术在使患者在六个月时逐渐减少麻醉药物用量方面效果更好。
