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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >OPIOID USE IN ADOLESCENTS FOLLOWING HIP AND KNEE ARTHROSCOPY
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OPIOID USE IN ADOLESCENTS FOLLOWING HIP AND KNEE ARTHROSCOPY

机译：髋关节和膝关节镜检查后青少年使用阿片类药物

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Background: The use and misuse of opioid medications has been declared an epidemic and public health emergency by the Centers for Disease Control. From 1999 – 2016, there was a 5-fold increase in overdose deaths secondary to opioids1. Pain control is an important component of post-operative care following orthopaedic surgery and opioid medications are commonly prescribed. The purpose of this study is to describe the average opioid use among adolescents following hip and knee arthroscopy. Methods: All patients less than 21 years of age undergoing ACL reconstruction, simple knee arthroscopy (plica and fat pad debridement, loose body removal, partial meniscectomy, or chondroplasty), and hip arthroscopy for femoroacetabular impingement were prospectively enrolled in this IRB-approved study. This is an interim report for an ongoing study with anticipated completion of enrollment in December 2018. All patients received hydrocodone-acetaminophen 5-325 mg for post-operative pain control. The number of pills prescribed was based on physician preference and was not dictated by the study. Patients and their families completed a medication logbook to track all doses of pain medication and associated pain scores. Risk factors for hydrocodone use following surgery were analyzed, including age, sex, race, pre-operative use of narcotic pain medications, surgical factors, and post-operative VAS pain scores. Results: A total of 65 patients were enrolled and completed the medication logbook, including 37 females and 28 males with a mean age of 15.6 years (range 7 – 20 years). Patients received a prescription for an average of 28 hydrocodone tablets (range 10 – 60) and 64 patients (98%) filled the prescription. The mean number and range of hydrocodone tablets consumed and remaining at the end of treatment and VAS pain scores at the time the patients consumed the pain medication are listed in the figure below. Forty-two patients (65%) reported one or more side effects from the hydrocodone, with the most common being drowsiness and constipation. There were no risk factors that predicted increased use of hydrocodone following ACL reconstruction or knee arthroscopy. Female sex and higher post-operative VAS pain scores predicted greater use of hydrocodone in patients following hip arthroscopy. Conclusions: Opioid medication use in adolescents following hip and knee arthroscopy is significantly less than the quantity of tablets prescribed, with 60% of the medication we prescribed remaining unused in the post-operative period. We recommend orthopaedic surgeons responsibly prescribe pain medications using evidence-based data or the results of their own experience monitoring medication consumption. Additionally, and important in the setting of the “opioid epidemic,” physicians must counsel patients and families of post-operative pain expectations and appropriate medication use. This study will provide the framework for the future development of educational resources regarding prescribing and use of pain medications for healthcare providers, patients, and caregivers. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2017 Procedure # Prescribed (range) # Consumed (range) # Remaining (range) VAS Pain ACL Reconstruction 30 (20 – 60) 15 (3 – 54) 16 (0 – 53) 7.1 (1.1 – 8.9) Knee Arthroscopy 22 (10 – 30) 7 (0 – 20) 13 (0 – 26) 6.0 (2.3 – 8.5) Hip Arthroscopy 30 (20 – 30) 8 (1 – 20) 21 (5 – 29) 6.7 (5.6 – 9.1)
机译：背景：阿片类药物的使用和滥用已被疾病控制中心宣布为流行病和公共卫生突发事件。从1999年到2016年，阿片类药物继发的过量用药死亡增加了5倍。疼痛控制是骨科手术后术后护理的重要组成部分，通常开处方使用阿片类药物。这项研究的目的是描述髋关节和膝关节镜检查后青少年平均使用阿片类药物的情况。方法：前瞻性地纳入了所有年龄小于21岁的患者，这些患者均接受了ACL重建，简单的膝关节镜检查（plica和脂肪垫清创术，松散的身体去除，部分半月板切除术或软骨成形术）以及髋关节镜检查以对股骨髋臼撞击进行研究。 。这是一项正在进行的研究的中期报告，预计于2018年12月完成注册。所有患者均接受氢可酮-对乙酰氨基酚5-325 mg用于术后疼痛控制。处方药的数量基于医生的喜好，并非由研究决定。患者及其家人填写了用药日志，以追踪止痛药的所有剂量以及相关的疼痛评分。分析了手术后使用氢可酮的危险因素，包括年龄，性别，种族，术前使用麻醉性止痛药，手术因素和术后VAS疼痛评分。结果：共有65例患者入组并完成了用药日志，其中37例女性和28例男性，平均年龄为15.6岁（范围7至20岁）。患者接受了平均28片氢可酮片的处方（范围为10-60），有64位患者（98％）接受了处方。下图列出了在治疗结束时消耗和保留的氢可酮片剂的平均数量和范围，以及患者服用止痛药时的VAS疼痛评分。 42名患者（65％）报告说氢可酮有一种或多种副作用，最常见的是嗜睡和便秘。没有危险因素可预测在ACL重建或膝关节镜检查后氢可酮的使用增加。女性和较高的术后VAS疼痛评分预示髋关节镜检查患者会更多使用氢可酮。结论：髋关节和膝关节镜检查后的青少年使用阿片类药物的次数明显少于处方药的量，我们处方的药物中有60％在术后期间仍未使用。我们建议骨科医生使用基于证据的数据或他们自己监控用药经验的结果，负责任地开处方止痛药。此外，在“阿片类药物流行病”的发生环境中，医生必须向患者及其家属提供术后疼痛预期和适当用药的建议，这对他们至关重要。这项研究将为医疗保健提供者，患者和护理人员处方和使用止痛药的教育资源的未来发展提供框架。流行病学研究的广泛在线数据（WONDER）。乔治亚州亚特兰大：疾病预防控制中心，国家卫生统计中心; 2017步骤＃处方（范围）＃消耗（范围）＃剩余（范围）VAS疼痛ACL重建30（20 – 60）15（3 – 54）16（0 – 53）7.1（1.1 – 8.9）膝关节镜检查22（10 – 30）7（0 – 20）13（0 – 26）6.0（2.3 – 8.5）髋关节镜检查30（20 – 30）8（1 – 20）21（5 – 29）6.7（5.6 – 9.1）

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