Jackson James Benjamin, Bakaes Yianni, Kelly William, Bian Julia, Bookstaver Paul Brandon, York Aly, Gonzalez Tyler
Prisma Health Department of Orthopaedics, Columbia, SC, USA.
University of South Carolina School of Medicine Columbia, Columbia, SC, USA.
Hosp Pharm. 2024 Dec 30:00185787241303721. doi: 10.1177/00185787241303721.
Opioids are often part of the post-operative pain regimen after orthopaedic surgery. Novel multimodal post-operative pain control regimens have been developed to decrease the amount of opioid usage due to their negative side effects including nausea, constipation, and addiction. The purpose of this study was to compare the cost of postoperative pain management treatment methods after orthopaedic surgery between opioid/acetaminophen therapy and an opioid-free, multidrug, multimodal pathway. This is a secondary analysis of data collected from 2 IRB approved prospective studies that evaluated pain control after elective orthopaedic surgery from a single institution. The first study analyzed the use of opioid medication after hallux valgus surgery and calculated the total cost of opioid pain medication consumed. The second study assessed the pain of patients after elective foot and ankle surgery utilizing a novel opioid-free multimodal pain pathway that included 5 medications. The postoperative prescription costs of these 2 pain management groups were totaled, analyzed, and compared. A paired -test was used to compare the means of these 2 groups and to evaluate whether significant differences might exist between them. We noted that the opioid group had an average cost of $8.92 (SD $5.74), while the opioid-free multimodal group had an average total cost of $25.60 (SD $10.49), < .001. The average difference in cost between the 2 regimens was $16.68. There was a statistically significant difference between the costs of an opioid-free multimodal post-operative pain regimen when compared to an opioid/acetaminophen therapy, irrespective of public vs private insurance. This 17-dollar cost difference may or may not be clinically significant depending on the financial situation of the patient, but it may be important for the clinician to consider to provide appropriate individualized patient care after orthopaedic surgery. II.
阿片类药物常用于骨科手术后的疼痛治疗方案。由于阿片类药物存在恶心、便秘和成瘾等副作用，新型多模式术后疼痛控制方案已被开发出来，以减少其使用量。本研究的目的是比较骨科手术后阿片类药物/对乙酰氨基酚疗法与无阿片类药物的多药多模式治疗途径在术后疼痛管理治疗方法上的成本。这是一项对从2项经机构审查委员会批准的前瞻性研究中收集的数据进行的二次分析，这2项研究评估了来自单一机构的择期骨科手术后的疼痛控制情况。第一项研究分析了拇外翻手术后阿片类药物的使用情况，并计算了所消耗的阿片类止痛药物的总成本。第二项研究采用一种包括5种药物的新型无阿片类药物多模式疼痛途径，评估了择期足踝手术后患者的疼痛情况。将这2个疼痛管理组的术后处方成本进行总计、分析和比较。采用配对t检验来比较这2组的均值，并评估它们之间是否可能存在显著差异。我们注意到，阿片类药物组的平均成本为8.92美元（标准差为5.74美元），而无阿片类药物的多模式组的平均总成本为25.60美元（标准差为10.49美元），P < 0.001。这2种治疗方案的平均成本差异为16.68美元。与阿片类药物/对乙酰氨基酚疗法相比，无阿片类药物的多模式术后疼痛治疗方案的成本在统计学上存在显著差异，无论患者是公共保险还是私人保险。这17美元的成本差异根据患者的财务状况可能具有临床意义，也可能不具有临床意义，但对于临床医生在骨科手术后提供适当的个体化患者护理而言，考虑这一点可能很重要。二、
