Bridges Tiffany N, Lazaro Johnlevi S, Clancy Dillon, Ford Elizabeth, Pontes Manuel, McMillan Sean
From the Jefferson Health New Jersey, Department of Orthopaedic Surgery (Dr. Bridges and Dr. Lazaro), Stratford, NJ; the Inspira Health, Department of Orthopaedic Surgery (Dr. Clancy and Dr. Ford), Vineland, NJ; Rowan University, College of Business (Dr. Pontes), Glassboro, NJ; and the Division of Orthopaedic Surgery (Dr. McMillan), Virtua Orthopaedics, Burlington, NJ.
J Am Acad Orthop Surg Glob Res Rev. 2025 Feb 3;9(2). doi: 10.5435/JAAOSGlobal-D-24-00152. eCollection 2025 Feb 1.
Healthcare institutions have sought to standardize opioid prescribing after elective total joint arthroplasty. The purpose of this study was (1) to compare opioid prescriptions at discharge with perceived opioid prescribing patterns and (2) to determine the relationship between preoperative adjunctive treatments and opioids prescribed at discharge.
All surgeons who performed total joint arthroplasty of the shoulder, hip, or knee from January 1, 2021, to October 4, 2023, at a single academic institution were included. Surgeons completed a survey assessing perceived opioid prescriptions at discharge and perioperative pain protocols. Actual prescriptions were captured using our institutional opioid database. All opioid prescriptions were converted to morphine milligram equivalents (MMEs).
Orthopaedic surgeons prescribed on average 594.2 MMEs more than they perceived as their postoperative protocol. They prescribed an additional 60.9 MMEs for every 10 MMEs that they perceived they were prescribing. Patients receiving liposomal bupivacaine were prescribed on average 597 fewer MMEs and had fewer opioid prescriptions (P < 0.001). Genicular nerve blocks and cryoneurolysis were associated with fewer prescribed MMEs (P < 0.001).
Orthopaedic surgeons prescribe substantially more opioids than intended. This study underscores the need for standardized opioid prescribing practices and the potential of adjunctive treatments in reducing opioid prescribing.
医疗机构一直在努力规范择期全关节置换术后的阿片类药物处方。本研究的目的是：（1）比较出院时的阿片类药物处方与感知到的阿片类药物处方模式；（2）确定术前辅助治疗与出院时开具的阿片类药物之间的关系。
纳入了2021年1月1日至2023年10月4日在单一学术机构进行肩部、髋部或膝部全关节置换术的所有外科医生。外科医生完成了一项调查，评估出院时感知到的阿片类药物处方和围手术期疼痛方案。使用我们机构的阿片类药物数据库获取实际处方。所有阿片类药物处方均转换为吗啡毫克当量（MME）。
骨科医生开具的阿片类药物平均比他们认为的术后方案多594.2 MME。他们每认为自己开具10 MME，就会额外多开60.9 MME。接受脂质体布比卡因治疗的患者平均少开597 MME的阿片类药物，且阿片类药物处方较少（P < 0.001）。膝状神经阻滞和冷冻神经溶解与开具的MME较少有关（P < 0.001）。
骨科医生开具的阿片类药物比预期多得多。本研究强调了规范阿片类药物处方实践的必要性以及辅助治疗在减少阿片类药物处方方面的潜力。
