A Prospective Evaluation of Opioid Utilization After Upper-Extremity Surgical Procedures: Identifying Consumption Patterns and Determining Prescribing Guidelines
A Prospective Evaluation of Opioid Utilization After Upper-Extremity Surgical Procedures: Identifying Consumption Patterns and Determining Prescribing Guidelines
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DOI：
10.2106/jbjs.15.00614
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发表时间：
2016-10-19
影响因子：
5.3
通讯作者：
Ilyas, Asif M.
中科院分区：
文献类型：
--
作者：
Kim, Nayoung;Matzon, Jonas L.;Ilyas, Asif M.
背景：虽然口服镇痛药对术后疼痛的适当管理是外科手术的一个重要方面，但无意的过量处方可能导致社区中阿片类药物的过度供应，从而导致潜在的转移。本研究的目的是前瞻性评估门诊上肢外科手术后阿片类药物的使用情况，以确定阿片类药物的使用模式并制定处方指南。方法：所有连续6个月接受上肢门诊手术的患者收集以下前瞻性数据：患者人口统计学特征、手术细节、麻醉类型、阿片类药物处方和消费模式。方差分析和事后比较采用t检验，多个两两检验的p值采用Bonferroni校正进行调整。结果：共纳入1416例患者，平均年龄56岁（范围18 ~ 93岁）。外科医生平均总共开了24片，患者报告平均总共吃了8.1片，导致使用率为34%。与骨折手术（13.0片，4.5天）或关节手术（14.5片，5.0天）相比，接受软组织手术的患者报告需要更少的阿片类药物（5.1片，2.2天）（p < 0.001）。与接受前臂或肘部手术的患者（11.1片）和接受上臂或肩部手术的患者（22.0片）相比，接受手腕手术的患者平均需要7.5片，持续3.1天，接受手部手术的患者平均需要7.7片，持续2.9天（p < 0.01）。手术类型、解剖位置、麻醉类型、年龄和保险类型也都与报告的阿片类药物消耗显著相关（p < 0.001）。结论：在这项对术后阿片类药物消耗的大型前瞻性评估中，我们发现患者在上肢手术后服用的阿片类药物大约是所需药物的3倍。我们提供了一般的处方指南，我们建议外科医生仔细检查患者的阿片类药物使用情况，并考虑根据解剖位置和手术类型定制阿片类药物处方，以开出最佳剂量的阿片类药物，同时避免过量的阿片类药物传播。
Background: Although adequate management of postoperative pain with oral analgesics is an important aspect of surgical procedures, inadvertent overprescribing can lead to excess availability of opioids in the community for potential diversion. The purpose of our study was to prospectively evaluate opioid consumption following outpatient upper-extremity surgical procedures to determine opioid utilization patterns and to develop prescribing guidelines.Methods: All patients undergoing outpatient upper-extremity surgical procedures over a consecutive 6-month period had the following prospective data collected: patient demographic characteristics, surgical details, anesthesia type, and opioid prescription and consumption patterns. Analysis of variance and post hoc comparisons were performed using t tests, with the p value for multiple pairwise tests adjusted by the Bonferroni correction.Results: A total of 1,416 patients with a mean age of 56 years (range, 18 to 93 years) were included in the study. Surgeons prescribed a mean total of 24 pills, and patients reported consuming a mean total of 8.1 pills, resulting in a utilization rate of 34%. Patients undergoing soft-tissue procedures reported requiring fewer opioids (5.1 pills for 2.2 days) compared with fracture surgical procedures (13.0 pills for 4.5 days) or joint procedures (14.5 pills for 5.0 days) (p < 0.001). Patients who underwent wrist surgical procedures required a mean number of 7.5 pills for 3.1 days and those who underwent hand surgical procedures required a mean number of 7.7 pills for 2.9 days, compared with patients who underwent forearm or elbow surgical procedures (11.1 pills) and those who underwent upper arm or shoulder surgical procedures (22.0 pills) (p < 0.01). Procedure type, anatomic location, anesthesia type, age, and type of insurance were also all significantly associated with reported opioid consumption (p < 0.001).Conclusions: In this large, prospective evaluation of postoperative opioid consumption, we found that patients are being prescribed approximately 3 times greater opioid medications than needed following upper-extremity surgical procedures. We have provided general prescribing guidelines, and we recommend that surgeons carefully examine their patients' opioid utilization and consider customizing their opioid prescriptions on the basis of anatomic location and procedure type to prescribe the optimal amount of opioids while avoiding dissemination of excess opioids.