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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Mandatory Prescription Limits and Opioid Use After Anterior Cruciate Ligament Reconstruction
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Mandatory Prescription Limits and Opioid Use After Anterior Cruciate Ligament Reconstruction

机译：强制处方限制和阿片类药物在前十字架韧带重建后使用

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Background: Because of the need for perioperative pain management, orthopaedic surgeons play an important role in opioid use. Purpose/Hypothesis: To evaluate the impact of opioid-limiting legislation on postoperative opioid use and pain-related complications after anterior cruciate ligament reconstruction (ACLR). The hypothesis was that the opioid-limiting legislation would reduce postoperative opioid use after ACLR. Study Design: Cohort study; level of evidence, 3. Methods: We retrospectively reviewed patients who underwent ACLR 1 year before and 1 year after Ohio's opioid-limiting legislation, which was passed in August 2017. Clinicians were prohibited from prescribing more than 30 morphine milligram equivalents (MMEs) per day, with a maximum duration of 7 days for adults. The Ohio Automated Rx Reporting System database and patients’ medical charts were reviewed for prescriptions of all controlled substances (oral oxycodone, hydrocodone, morphine, codeine, tramadol, and hydromorphone) filled from 30 days before and 90 days after ACLR. The total number of postoperative prescriptions, total MMEs, the number of pills in each patient’s prescription, and pain-related complications (emergency department visits, office calls for pain control issues, unplanned readmissions, unplanned surgeries, and provider notes indicating opioid prescription refill demands) were evaluated. Results: A total of 243 patients (127 prelegislation, 116 postlegislation) were included in the study. There were no significant differences in demographics or preoperative opioid use between the study groups. The number of pills prescribed initially decreased by 34% after legislation (63.5 ± 16.7 [prelegislation] vs 42 ± 15.7 pills [postlegislation]; P & .001). Correspondingly, there was a significant decrease in total quantity of initial prescriptions in the postlegislation period (474.6 ± 123.8 vs 310.7 ± 115.3 MMEs; P & .001). The number of documented pain medication refill demands and pain-related complications did not increase in the postlegislation period (42 prelegislation vs 43 postlegislation; P = .514). Preoperative opioid use was the strongest predictor of opioid-refill demand (odds ratio, 4.19 [95% CI, 1.76-9.99]; P = .001). Conclusion: After the Ohio legislation was passed limiting opioid prescription, there was a significant reduction in opioids provided for patients undergoing ACLR. In spite of this decrease, no rebound increase in refill demands or postoperative pain-related complications were observed.
机译：背景：由于需要围手术期疼痛管理，骨科外科医生在阿片类药物中发挥着重要作用。目的/假设：评估阿片异己限制立法对术后阿片类药物的影响和前令韧带重建（ACLR）后的疼痛相关并发症。假设是，阿片式限制立法将减少ACLR后术后阿片类药物。研究设计：队列研究;证据水平，3.方法：我们回顾性地审查了俄亥俄州阿片类药物限制立法后1年前接受ACLR的患者，该立法于2017年8月通过。临床医生被禁止按照30多个吗啡毫克等当量（MME）一天，成人最长持续7天。俄亥俄州自动化RX报告系统数据库和患者的医疗图表被审查了所有受控物质（口服羟氢酮，氢酮，吗啡，可待因，曲马多，氢麦酮）在ACLR之前的30天和90天之前填充的。术后处方的总数，总MME，每位患者处方药中的药丸数量和与疼痛有关的并发症（急诊部门访问，办公室呼吁止痛药，无计划的入院，无计划的手术和提供者注意事项表明阿片类药物补充要求）评估。结果：该研究中共有243名患者（127名患者，116名末期）。研究组之间的人口统计数据或术前阿片类药物使用没有显着差异。立法后，规定的药丸数量初步下降了34％（63.5±16.7℃，与42±15.7丸[末期]; P＆amp; LT; .001）。相应地，近期出现期间的初始处方数量的总数显着降低（474.6±123.8 Vs 310.7±115.3 mmes; p＆amp; .001）。记录的止痛药补充要求的数量补充要求和疼痛相关的并发症在近期来期间没有增加（42次预制率与43次次数; P = .514）。术前阿片类药物的使用是阿片类药物再填充需求的最强预测因子（差距，4.19 [95％CI，1.76-9.99]; p = .001）。结论：通过限制阿片类药物的俄亥俄州立法后，为接受ACLR的患者提供了显着的表述药物。尽管这一减少，但尚未观察到补充需求或术后疼痛相关的并发症的反弹增加。

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