Developing and Testing an Opioid Taper Intervention Before Total Knee Arthroplasty

项目总结 膝骨性关节炎是美国慢性疼痛最常见的原因之一，也是常见的原因 患者长期服用阿片类药物止痛。全膝关节置换术常用于治疗晚期膝关节 骨关节炎，美国每年有近100万名患者接受全膝关节置换术。许多 接受全膝关节置换术的患者术前服用阿片类药物。然而，术前阿片类药物 使用与术后疼痛加重、并发症发生率高和术后阿片类药物增加有关 使用。即使是小剂量的阿片类药物也会导致依赖和痛觉过敏，因此术后疼痛可能更难 长期服用阿片类药物的患者的控制，这可能会导致更困难的康复 手术后。术前逐渐减少阿片类药物有可能改善全膝关节置换术的结果 抵消阿片类药物的这些负面影响。然而，现有的关于术前阿片类药物缩减的文献是 有限的。几项小规模的回溯性研究显示了一种益处，但详细的术前缩减方案 还没有发表，也没有进行高质量的前瞻性研究。这项建议看起来像是 推进术前阿片类药物减量领域。目标1将开发和完善术前阿片类药物减量 接受全膝关节置换术患者的方案。目标2将评估术前使用阿片类药物的可行性 先导性随机试验中的锥形干预。在AIM 2的试点试验结束后，干预措施将是 作为这项研究的下一步，准备在多中心随机对照试验中测试疗效。这个 这项为期4年、以患者为导向的研究职业发展奖(K23)计划的总体目标是 支持凯文·里格斯，医学博士，公共卫生硕士，成为改善关节置换领域的独立研究员 结果，重点是疼痛和阿片类药物的使用。该奖项将提供全面的指导、培训和 帮助里格斯博士成为一名独立研究人员的研究经验。 具体地说，里格斯博士将在开发干预措施、临床试验设计和评估 功能状态和其他患者报告的结果衡量标准。这将使里格斯博士成为一名领导者 在改善关节置换术患者的手术结果方面。

PROJECT SUMMARY Osteoarthritis of the knee is one of the most common causes of chronic pain in the US, and a common reason that patients take long-term opioids for pain. Total knee arthroplasty is often used to treat advanced knee osteoarthritis, with nearly a million patients undergoing total knee arthroplasty in the US each year. Many patients who undergo total knee arthroplasty are taking opioids preoperatively. However, preoperative opioid use is associated with worse postoperative pain, higher complication rates, and higher postoperative opioid use. Even low dose opioids can induce dependence and hyperalgesia, so postoperative pain can be harder to control in patients who have been taking chronic opioids, which can then lead to more difficult rehabilitation after surgery. Tapering opioids preoperatively holds potential to improve outcomes in total knee arthroplasty by counteracting these negative effects of opioids. However, the existing literature on preoperative opioid taper is limited. Several small retrospective studies have suggested a benefit, but detailed preoperative taper protocols have not been published, and high quality prospective studies have not been conducted. This proposal looks to advance the field of preoperative opioid tapering. Aim 1 will develop and refine a preoperative opioid taper protocol for patients undergoing total knee arthroplasty. Aim 2 will assess the feasibility of preoperative opioid taper intervention in a pilot randomized trial. At the completion of the pilot trial in Aim 2, the intervention will be ready to be tested for efficacy in a multicenter randomized control trial as the next step in this research. The overall goal of this 4-year Mentored Patient-Oriented Research Career Development Award (K23) proposal is to support Kevin Riggs, MD, MPH to become an independent investigator in the field of improving arthroplasty outcomes, with a focus on pain and opioid use. This award will provide comprehensive mentoring, training, and research experience to facilitate Dr. Riggs’s progression toward becoming an independent investigator. Specifically, Dr. Riggs will gain expertise in developing interventions, clinical trial design, and evaluation of functional status and other patient-reported outcome measures. This will position Dr. Riggs to become a leader in improving surgical outcomes for patients undergoing arthroplasty.