青少年四头肌腱前交叉韧带重建术后第3 - 7天阿片类药物使用和疼痛减轻

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-12-01 Epub Date: 2025-10-23 DOI:10.1016/j.asmr.2025.101289

Christopher J. DeFrancesco M.D. , Morgan Swanson B.A. , Brendan A. Williams M.D. , Vineet M. Desai M.D. , Richa Gandhi B.A. , Divya Talwar Ph.D. , Theodore J. Ganley M.D.

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引用次数: 0

摘要

目的了解青少年自体四头肌肌腱（QT）前交叉韧带（ACL）重建术后一周内的疼痛水平和阿片类药物消耗情况。方法选取19岁的青少年，在手术时采用全内技术进行前交叉韧带QT重建。所有患者均行股神经和坐骨神经阻滞全身麻醉。一组患者留置股神经导管直至术后1天（POD） 2。通过调查记录数字评定量表疼痛水平（0-10级）和阿片类药物在规定时间间隔（手术当晚4点至12点，POD1上午12点至8点，POD1、POD3和POD7上午8点至4点）的使用情况。排除了至少一半疼痛调查未返回的患者，并且所有患者都至少进行了POD3随访。总结疼痛程度，并在有和没有股神经导管的亚组之间进行两两比较。采用单变量检验来评估记录变量与POD3阿片类药物使用或POD3疼痛≥5的结果之间的关系。结果共纳入58例患者。处方中位数为15片5毫克羟考酮。在POD3中，26.8%的患者报告疼痛≥5,26.8%的患者报告使用阿片类药物。在POD7中，5.5%的患者报告疼痛≥5,3.6%的患者报告使用阿片类药物。总共有35.2%的人从未报告过阿片类药物的使用。留置股神经导管的患者在术后晚上上午12点至上午8点期间阿片类药物消耗较低（0%对37.8%,P = 0.006），尽管该时间段的疼痛评分相似（中位数3/10对4/10，P = 0.153）。只需要补充1次阿片类药物。结论：青少年ACL QT重建后，中度疼痛可持续3天，甚至局部阻滞。然而，在POD7中，实质性疼痛和阿片类药物的使用并不常见。证据水平：IV级，回顾性治疗病例系列。

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Opioid Use and Pain Decrease Between Days 3 and 7 After Quadriceps Tendon Anterior Cruciate Ligament Reconstruction in Adolescents

Purpose

To detail pain levels and opioid consumption in the week following quadriceps tendon autograft (QT) anterior cruciate ligament (ACL) reconstruction among adolescents.

Methods

Adolescents (<19 years) undergoing ACL reconstruction with QT using an all-inside technique were enrolled at the time of surgery. All underwent general anesthesia with femoral and sciatic nerve blocks. A subset had an indwelling femoral nerve catheter until postoperative day (POD) 2. Numeric Rating Scale pain level (scale 0-10) and opioid use at defined intervals (4 PM to 12 AM the evening of surgery, 12 AM to 8 AM on POD1, 8 AM to 4 PM on POD1, POD3, and POD7) were recorded via surveys. Patients who did not return at least half of their pain surveys were excluded, and all had a minimum of POD3 follow-up. Pain levels were summarized, and pairwise comparisons between the subgroups with and without femoral nerve catheters were done. Univariate tests were performed to evaluate the association between recorded variables and outcomes of POD3 opioid use or POD3 pain ≥5.

Results

Fifty-eight patients were included. A median of 15 tablets of 5 mg of oxycodone were prescribed. On POD3, 26.8% of patients reported pain ≥5, and 26.8% reported opioid use. On POD7, 5.5% of patients reported pain ≥5, and 3.6% reported opioid use. In total, 35.2% never reported opioid use. Patients with indwelling femoral nerve catheters had lower opioid consumption during the 12 AM to 8 AM timeframe the night after surgery (0% vs 37.8%, P = .006), despite similar pain scores in this time frame (median 3/10 vs 4/10, P = .153). Only 1 opioid refill was required.

Conclusions

In adolescents, moderate pain may persist for 3 days after ACL reconstruction with QT, even with regional blocks. However, both substantial pain and opioid use are uncommon at POD7.