Reasons for Preoperative Opioid Use Are Associated with Persistent Use following Surgery Among Patients Undergoing Total Knee and Hip Arthroplasty
Reasons for Preoperative Opioid Use Are Associated with Persistent Use following Surgery Among Patients Undergoing Total Knee and Hip Arthroplasty
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DOI：
10.1093/pm/pnab322
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发表时间：
2021-11-12
期刊：
影响因子：
3.1
通讯作者：
McAfee, Jenna
中科院分区：
文献类型：
--
作者：
Ervin-Sikhondze, Brittany A.;Moser, Stephanie E.;McAfee, Jenna
Objective.大多数关于术前阿片类药物使用的研究仅描述了患者是否使用阿片类药物，而没有描述使用原因。了解患者使用阿片类药物的原因有助于告知围手术期阿片类药物管理。本研究的目的是探索全髋关节和膝关节置换术（THA和TKA）前术前使用阿片类药物的疼痛特异性原因及其与持续使用的相关性。方法.这是一项前瞻性研究，纳入了2015年12月至2018年11月期间入组镇痛结局研究的197例接受THA（n = 99）或TKA（n = 98）的患者。所有参与者均报告了术前阿片类药物使用情况。结果术前阿片类药物使用的原因被分类为仅手术部位疼痛（81例[41.1%]）;仅其他身体部位疼痛（22例[11.2%]）;和合并疼痛（94例[47.7%]）。与服用阿片类药物治疗手术部位疼痛的患者相比，在术后3个月和6个月时，合并使用原因的患者持续使用阿片类药物的几率分别为1.24（P = .40）和2.28（P = .16），调整相关协变量。结论.本研究为THA或TKA患者术前使用阿片类药物的原因异质性提供了新的见解。一个关键的问题是，并非所有术前阿片类药物的使用都是相同的，许多患者在术前服用阿片类药物不仅仅是为了手术部位的疼痛。使用的综合原因与长期使用有关，这表明非手术疼痛在一定程度上促使手术后持续使用阿片类药物。围手术期护理的未来方向应侧重于术前阿片类药物使用的疼痛和非疼痛原因，以制定量身定制的术后阿片类药物撤机计划。
Objective. Most studies on preoperative opioid use only describe whether or not patients use opioids without characterizing reasons for use. Knowing why patients use opioids can help inform perioperative opioid management. The objective of this study was to explore pain specific reasons for preoperative opioid use prior to total hip and knee arthroplasty (THA and TKA) and their association with persistent use. Methods. This is a prospective study of 197 patients undergoing THA (n = 99) or TKA (n = 98) enrolled in the Analgesic Outcomes Study between December 2015 and November 2018. All participants reported preoperative opioid use. Results. Reasons for preoperative opioid use were categorized as surgical site pain only (81 [41.1%]); pain in other body areas only (22 [11.2%]); and combined pain (94 [47.7%]). Compared to patients taking opioids for surgical site pain, those with combined reasons for use had 1.24 (P = .40) and 2.28 (P = .16) greater odds of persistent use at 3 and 6 months postoperatively, adjusting for relevant covariates. Conclusions. This study provides novel insights into the heterogeneity of reasons for presurgical opioid use in patients undergoing a THA or TKA. One key take away is that not all preoperative opioid use is the same and many patients are taking opioids preoperatively for more than just pain at the surgical site. Combined reasons for use was associated with long-term use, suggesting nonsurgical pain, in part, drives persistent opioid use after surgery. Future directions in perioperative care should focus on pain and non-pain reasons for presurgical opioid use to create tailored postoperative opioid weaning plans.