Hale Martina E, Ramos Michael S, Laporte Collin J, Kline Theresa, Spindler Kurt P, Scarcella Michael J
Cleveland Clinic, Cleveland, Ohio, USA.
Orthop J Sports Med. 2025 Jul 14;13(7):23259671251353751. doi: 10.1177/23259671251353751. eCollection 2025 Jul.
Uniform, data-driven guidelines for oral opioid prescriptions after anterior cruciate ligament reconstruction (ACLR) are lacking.
To provide a concise, systematic review of literature quantifying postoperative opioid pill consumption in patients who underwent ACLR.
Systematic review; Level of evidence, 4.
Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a literature search was performed using Ovid MEDLINE, Ovid Embase, Scopus, and Cochrane CENTRAL databases from inception to August 12, 2022. Search terms included "anterior cruciate ligament reconstruction," "opiate alkaloids," "hydrocodone," "oxycodone," and "narcotics." In total, 752 unique studies were identified. Studies were included if they quantified postoperative oral opioid consumption for ≥4 postoperative days. Exclusion criteria included pediatric studies, abstracts or conference papers, reviews, unpublished randomized controlled trials, case reports, and papers not in the English language. For each included study, the following data were extracted: number of pills in initial prescription, type of pill prescribed, and size of any additional prescriptions given after initial prescription. We also recorded the intervention or context for which prescription size was being investigated. The methodological index for non-randomized studies criteria were used to evaluate the quality of all included studies.
A total of 20 articles were included in the study. For all studies, regardless of postoperative period length, oral opioid consumption ranged from 2.3 ± 2.9 tablets of 5-mg oxycodone (17.3 MMEs) to 32.2 ± 15.9 tablets of 5-mg oxycodone (242 MMEs). Specifically, for studies reporting on oral opioid consumption within the first 7 postoperative days, consumption ranged from 3.0 tablets of 5-mg oxycodone to 32.2 tablets of 5-mg oxycodone. No study reported consumption >35 tablets. Effective ways to decrease postoperative opioid consumption included preoperative adductor canal blocks, intraoperative bupivacaine local anesthetic injection, and postoperative multimodal analgesic regimens.
Our review demonstrated that several pre- and postoperative interventions, including preoperative regional nerve blocks, use of infiltrative local anesthetics like bupivacaine or a similar agent, as well as multimodal analgesic regimens, can decrease perioperative pain and therefore decrease postoperative oral opioid consumption. Due to the heterogeneity of the available literature, no conclusions can be made as to what single nonopioid analgesic, or combination thereof, is optimal. However, this systematic review sets the foundation for future studies investigating opioid consumption in settings of nonopioid analgesic medications such as ketorolac and multimodal analgesic regimens.
目前缺乏关于前交叉韧带重建（ACLR）术后口服阿片类药物处方的统一、数据驱动的指南。
对量化接受ACLR患者术后阿片类药物片消耗量的文献进行简明、系统的综述。
系统综述；证据等级，4级。
采用PRISMA（系统评价和Meta分析的首选报告项目）指南，使用Ovid MEDLINE、Ovid Embase、Scopus和Cochrane CENTRAL数据库从建库至2022年8月12日进行文献检索。检索词包括“前交叉韧带重建”“阿片生物碱”“氢可酮”“羟考酮”和“麻醉药”。共识别出752项独特研究。若研究量化了术后至少4天的口服阿片类药物消耗量，则纳入研究。排除标准包括儿科研究、摘要或会议论文、综述、未发表的随机对照试验、病例报告以及非英文论文。对于每项纳入研究，提取以下数据：初始处方中的药片数量、所开药片类型以及初始处方后给予的任何额外处方的量。我们还记录了调查处方量所针对的干预措施或背景情况。使用非随机研究方法学指标标准来评估所有纳入研究的质量。
该研究共纳入20篇文章。对于所有研究，无论术后时长如何，口服阿片类药物消耗量范围为2.3±2.9片5毫克羟考酮（17.3毫克吗啡当量）至32.2±15.9片5毫克羟考酮（242毫克吗啡当量）。具体而言，对于报告术后前7天内口服阿片类药物消耗量的研究，消耗量范围为3.0片5毫克羟考酮至32.2片5毫克羟考酮。没有研究报告消耗量超过35片。减少术后阿片类药物消耗量的有效方法包括术前内收肌管阻滞、术中布比卡因局部麻醉注射以及术后多模式镇痛方案。
我们的综述表明，包括术前区域神经阻滞、使用布比卡因等浸润性局部麻醉药或类似药物以及多模式镇痛方案在内的多种术前和术后干预措施，可减轻围手术期疼痛，从而减少术后口服阿片类药物消耗量。由于现有文献的异质性，对于哪种单一非阿片类镇痛药或其组合是最佳的，无法得出结论。然而，这项系统综述为未来研究在非阿片类镇痛药（如酮咯酸）和多模式镇痛方案背景下的阿片类药物消耗量奠定了基础。
