一项试验性多中心随机临床试验,旨在确定在全髋关节或膝关节置换术前由药剂师协助进行阿片类药物减量干预的效果。

IF 7.5 1区 医学 Q1 ANESTHESIOLOGY
Anaesthesia Pub Date : 2024-07-31 DOI:10.1111/anae.16390
Shania Liu, Asad E. Patanwala, Jennifer Stevens, Jonathan Penm, Justine Naylor, the OpioidHALT Study Investigators and Coordinators
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引用次数: 0

摘要

背景:全髋关节或膝关节置换术前使用阿片类镇痛药与较差的术后效果有关。这项试验性研究旨在探讨在选择性初级髋关节或膝关节置换术前,由药剂师配合进行远程医疗阿片类药物减量干预的可行性,以及与常规护理相比的潜在效果:这项研究在澳大利亚新南威尔士州的七家医院进行。符合条件的患者年龄≥18岁,计划因骨关节炎接受初级髋关节或膝关节置换术,术前服用阿片类镇痛药。干预组在术前3个月至手术当天参加由药剂师和全科医生合作开展的阿片类药物减量远程医疗服务,而对照组则接受常规护理。研究的主要结果是调查干预的可行性(即治疗的依从性)以及在手术前将每日阿片类药物基线剂量减少50%以上的潜在有效性:2021年12月至2023年6月期间,共招募了70名患者,并随机分配到干预组(35人)或对照组(35人)。两组的基线特征相似。每组各有 30 名患者完成了分配的治疗。所有被分配到干预组的患者都至少完成了一次与药剂师的预约,预约次数的中位数(IQR [范围])为 2 次(1-4 [1-6])。在手术前成功将每日阿片类药物基线剂量减少≥50%的患者中,干预组有27/30人,而常规护理组只有5/30人(P,结论):这项试点研究的结果支持为计划接受初级髋关节或膝关节置换术的患者提供由药剂师合作的远程医疗阿片类药物减量服务的可行性。有必要进行更广泛的多中心研究,以检验这种干预措施对临床结果的有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

A pilot multicentre randomised clinical trial to determine the effect of a pharmacist-partnered opioid tapering intervention before total hip or knee arthroplasty

A pilot multicentre randomised clinical trial to determine the effect of a pharmacist-partnered opioid tapering intervention before total hip or knee arthroplasty

Background

Opioid analgesic use before total hip or knee arthroplasty has been associated with worse postoperative outcomes. This pilot study aimed to examine the feasibility of a telehealth-based pharmacist-partnered opioid tapering intervention before elective primary hip or knee arthroplasty and its potential effectiveness compared with usual care.

Methods

This study was conducted at seven hospitals in New South Wales, Australia. Eligible patients were those aged ≥ 18 years, scheduled to undergo primary hip or knee arthroplasty for osteoarthritis and taking opioid analgesics pre-operatively. The intervention group participated in an opioid tapering telehealth service, a partnership between a pharmacist and general practitioner, for 3 months pre-operatively up to the day of surgery, while the control group received usual care. The primary outcomes of the study were to investigate the feasibility of the intervention (i.e. adherence to treatment) and potential effectiveness in decreasing baseline daily opioid dose by > 50% before surgery.

Results

Between December 2021 and June 2023, 70 patients were recruited and assigned randomly to the intervention group (n = 35) or control group (n = 35). Baseline characteristics were similar between groups. Thirty patients in each group completed their allocated treatment. All patients allocated to the intervention group completed at least one appointment with a pharmacist, with the median (IQR [range]) being 2 (1–4 [1–6]) appointments. The number of patients who successfully decreased their baseline daily opioid dose by ≥ 50% before surgery was 27/30 in the intervention group compared with 5/30 in the usual care group (p < 0.001).

Conclusions

The findings of this pilot study support the feasibility of a telehealth-delivered, pharmacist-partnered opioid tapering service for patients scheduled for primary hip or knee arthroplasty. A broader multicentre study to examine the effectiveness of this intervention on clinical outcomes is warranted.

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来源期刊
Anaesthesia
Anaesthesia 医学-麻醉学
CiteScore
21.20
自引率
9.30%
发文量
300
审稿时长
6 months
期刊介绍: The official journal of the Association of Anaesthetists is Anaesthesia. It is a comprehensive international publication that covers a wide range of topics. The journal focuses on general and regional anaesthesia, as well as intensive care and pain therapy. It includes original articles that have undergone peer review, covering all aspects of these fields, including research on equipment.
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