Acute Pain Is Associated With Chronic Opioid Use After Total Knee Arthroplasty.
Acute Pain Is Associated With Chronic Opioid Use After Total Knee Arthroplasty.
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DOI：
10.1097/aap.0000000000000831
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发表时间：
2018-10
影响因子：
5.1
通讯作者：
Raghunathan K
中科院分区：
文献类型：
--
作者：
Hsia HL;Takemoto S;van de Ven T;Pyati S;Buchheit T;Ray N;Wellman S;Kuo A;Wallace A;Raghunathan K
补充的数字内容可在文本中找到。在临床实践中，疼痛评分是常规报告的，我们想在考虑了术前和围手术期阿片类药物使用人群的变量后，研究这种常规测量的、患者报告的变量是否提供了预后信息，特别是关于慢性阿片类药物使用的信息。在2010年至2015年期间，在退伍军人事务医院接受初级全膝关节置换术的32,874名术前阿片类药物使用者中，我们比较了报告较低和较高急性疼痛的患者的术前和围手术期特征（1-3天平均评分≤4/10 vs bb0 4/10）。我们根据所有可获得的数据计算了轻度急性疼痛的倾向。在1:1倾向评分匹配后，为了识别仅在急性疼痛方面存在差异的相似患者，我们对比了术后3个月后慢性显著阿片类药物使用率（吗啡当量平均> - 30mg /d）、出院处方以及术后与术前剂量类别的变化。敏感性分析检查了与剂量递增的关系。慢性显著阿片类药物使用率（总体21%）在急性疼痛较轻和较重的患者中存在差异（36%对64%）。经过倾向匹配（总n = 20,926例患者）并对所有显著因素进行调整后，较低的急性疼痛与较少的慢性显著阿片类药物使用（比率12% vs 16%），较少的出院处方（即供应<30天，每日口服吗啡当量<30 mg/d）以及更多的剂量减少相关，均P < 0.001。在敏感性分析中，急性疼痛越轻，剂量增加的可能性降低15%（优势比为0.85；95%可信区间为0.80-0.91）。急性疼痛预示着阿片类药物的长期使用。就长期效果而言，需要对减少急性疼痛的努力进行前瞻性研究。
Supplemental digital content is available in the text. Pain scores are routinely reported in clinical practice, and we wanted to examine whether this routinely measured, patient-reported variable provides prognostic information, especially with regard to chronic opioid use, after taking preoperative and perioperative variables into account in a preoperative opioid user population. In 32,874 preoperative opioid users undergoing primary total knee arthroplasty at Veterans Affairs hospitals between 2010 and 2015, we compared preoperative and perioperative characteristics in patients reporting lower versus higher acute pain (scores ≤4/10 vs >4/10 averaged over days 1–3). We calculated the propensity for lower acute pain based on all available data. After 1:1 propensity score matching, to identify similar patients differing only in acute pain, we contrasted rates of chronic significant opioid use (mean >30 mg/d in morphine equivalents) beyond postoperative month 3, discharge prescriptions, and changes in postoperative versus preoperative dose categories. Sensitivity analysis examined associations with dose escalation. Rates of chronic significant opioid use (21% overall) differed in patients with lower versus higher acute pain (36% vs 64% of the overall cohort). After propensity matching (total n = 20,926 patients) and adjusting for all significant factors, lower acute pain was associated with less chronic significant opioid use (rates 12% vs 16%), smaller discharge prescriptions (ie, supply <30 days and daily oral morphine equivalent <30 mg/d), and more reduction in dose, all P < 0.001. In sensitivity analysis, dose escalation was 15% less likely with lower acute pain (odds ratio, 0.85; 95% confidence interval, 0.80–0.91). Acute pain predicts chronic opioid use. Prospective studies of efforts to reduce acute pain, in terms of long-term effects, are needed.