在踝关节和胫骨远端骨折手术中,区域麻醉降低了住院患者对阿片类药物的需求,但没有降低门诊患者的需求。

IF 1.8 Q2 ORTHOPEDICS
Daniel J Cunningham, Ariana Paniagua, Isabel DeLaura, Gloria Zhang, Billy Kim, Jonathan Kim, Terry Lee, Micaela LaRose, Samuel Adams, Mark J Gage
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引用次数: 0

摘要

区域麻醉(RA)常用于踝关节和胫骨远端骨折手术。然而,这种治疗对住院和门诊阿片类药物需求的实际影响尚不清楚。假设与未接受RA的患者相比,接受踝关节和胫骨远端骨折手术的患者RA会减少住院阿片类药物的消耗,对门诊需求的影响很小。方法本研究纳入2013年7月至2018年7月在同一医院接受踝关节和胫骨远端骨折手术的所有18岁及以上患者(n = 1310)。住院阿片类药物消耗(术后0-72小时)和门诊阿片类药物处方(术前1个月至术后90天)以羟可酮5毫克当量(OEs)记录。采用调整后的模型评估类风湿性关节炎与非类风湿性关节炎对住院和门诊阿片类药物需求的影响。结果与RA患者相比,无RA患者高能量机制损伤、附加损伤、开放性骨折和附加手术的发生率更高。调整后的模型显示,RA患者的住院阿片类药物消耗减少(术后0 - 24小时无RA的OEs估计为12.1 vs RA的OEs估计为8.8,P < 0.001),但此后无显著差异(术后24 - 48小时为9.7 vs 10.4, 48 - 72小时为9.5 vs 8.5)。在所有时间点,接受RA的患者估计门诊累计阿片类药物需求显著增加(术前1个月至2周,无RA的112.5次OEs vs有RA的137.3次OEs, 125.6次vs 155.5次OEs至6周,134.6次vs 163.3次OEs至90天,RA的P值均< 0.001)。在踝关节和胫骨远端骨折手术中,RA与早期住院阿片类药物需求减少有关,但在调整基线患者和治疗特征后,RA与门诊阿片类药物需求显著增加有关。本研究鼓励使用类风湿性关节炎来减少住院阿片类药物的使用,尽管门诊阿片类药物需求的增加令人担忧。证据水平III级:回顾性、治疗性队列研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Regional Anesthesia Decreases Inpatient But Not Outpatient Opioid Demand in Ankle and Distal Tibia Fracture Surgery.

Introduction: Regional anesthesia (RA) is commonly used in ankle and distal tibia fracture surgery. However, the pragmatic effects of this treatment on inpatient and outpatient opioid demand are unclear. The hypothesis was that RA would decrease inpatient opioid consumption and have little effect on outpatient demand in patients undergoing ankle and distal tibia fracture surgery compared with patients not receiving RA.

Methods: All patients aged 18 years and older undergoing ankle and distal tibia fracture surgery at a single institution between July 2013 and July 2018 were included in this study (n = 1310). Inpatient opioid consumption (0-72 hours postoperatively) and outpatient opioid prescribing (1 month preoperatively to 90 days postoperatively) were recorded in oxycodone 5-mg equivalents (OEs). Adjusted models were used to evaluate the impact of RA versus no RA on inpatient and outpatient opioid demand.

Results: Patients without RA had higher rates of high-energy mechanism of injury, additional injuries, open fractures, and additional surgery compared with patients with RA. Adjusted models demonstrated decreased inpatient opioid consumption in patients with RA (12.1 estimated OEs without RA vs 8.8 OEs with RA from 0 to 24 hours postoperatively, P < .001) but no significant difference after that time (9.7 vs 10.4 from 24 to 48 hours postoperatively, and 9.5 vs 8.5 from 48 to 72 hours postoperatively). Estimated cumulative outpatient opioid demand was significantly increased in patients receiving RA at all time points (112.5 OEs without RA vs 137.3 with RA from 1 month preoperatively to 2 weeks, 125.6 vs 155.5 OEs to 6 weeks, and 134.6 vs 163.3 OEs to 90 days, all P values for RA <.001).

Discussion: In ankle and distal tibia fracture surgery, RA was associated with decreased early inpatient opioid demand but significantly increased outpatient demand after adjusting for baseline patient and treatment characteristics. This study encourages the use of RA to decrease inpatient opioid use, although there was a worrisome increase in outpatient opioid demand.

Level of evidence: Level III: Retrospective, therapeutic cohort study.

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来源期刊
Foot and Ankle Specialist
Foot and Ankle Specialist Health Professions-Podiatry
CiteScore
3.10
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