The James A. Rand Young Investigator's Award: Large Opioid Prescriptions Are Unnecessary After Total Joint Arthroplasty: A Randomized Controlled Trial

被引:55
作者
Hannon, Charles P. [1 ]
Calkins, Tyler E. [1 ]
Li, Jefferson [1 ]
Culvern, Chris [1 ]
Darrith, Brian [1 ]
Nam, Denis [1 ]
Gerlinger, Tad L. [1 ]
Buvanendran, Asokumar [2 ]
Della Valle, Craig J. [1 ]
机构
[1] Rush Univ, Adult Reconstruct Div, Dept Orthopaed Surg, Med Ctr, 1611 West Harrison St, Chicago, IL 60612 USA
[2] Rush Univ, Dept Anesthesiol, Med Ctr, Chicago, IL 60612 USA
关键词
opioids; narcotics; arthroplasty; prescriptions; multimodal analgesia; TOTAL KNEE ARTHROPLASTY; PREDICTORS; PAIN; HIP; MEDICATION; REVISION; PATTERNS;
D O I
10.1016/j.arth.2019.01.065
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: The purpose of this randomized controlled trial is to determine whether the quantity of opioid pills prescribed at discharge is associated with the number of opioid pills consumed or unused by patients after primary hip and knee arthroplasty within 30 days after discharge. Methods: A total of 304 opioid-naive patients were randomized to receive either 30 or 90 5-mg oxycodone immediate-release (OxyIR) pills at discharge. Daily opioid consumption, number of unused pills, and pain scores were calculated for 30 days with a patient-completed medication diary. Statistical analysis involved t-test, rank-sum, chi-squared tests, and multiple linear regression with alpha = 0.05. Results: Of the 304 patients randomized, 161 patients were randomized to receive 30 pills and 143 to receive 90. In the first 30 days after discharge, the median number of unused pills was 15 in the 30 group vs 73 in the 90 group (P <.001). Within 90 days of discharge, 26.7% of the 30 group and 10.5% of the 90 group requested a refill (P <.001), leading to a mean of 777.1 +/- 414.2 morphine equivalents vs 1089.7 +/- 536.4 prescribed (P <.0001). There was no difference between groups in mean morphine equivalents consumed. Regression analysis demonstrated that being prescribed 90 OxyIR pills was independently associated with taking more OxyIR pills (P = .028). There was no difference in pain scores within the first 30 days and in patient-reported outcome scores at 6 weeks postoperatively. Conclusion: Prescribing fewer OxyIR pills is associated with a significant reduction in unused opioid pills and decreased opioid consumption with no increase in pain scores and no difference in patient-reported outcomes. (C) 2019 Elsevier Inc. All rights reserved.
引用
收藏
页码:S4 / S10
页数:7
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