【原】【罂粟摘要】膝关节和髋关节置换术后的院外阿片类药物处方：处方医生科室和首次处方的阿片类药物

膝关节和髋关节置换术后的院外阿片类药物处方：处方医生科室和首次处方的阿片类药物

贵州医科大学    麻醉与心脏电生理课题组

翻 译：佟睿   编 辑：柏雪    审 校：曹莹

背景：我们于2013年至2018年在荷兰确定了首次处方阿片类药物及膝关节和髋关节置换术(KA/HA)后阿片类药物的处方医生的科室。我们还评估了首次处方阿片类药物剂量是否与术后第一年的总分配剂量和长期使用阿片类药物有关。

方法：荷兰药物统计基金会和荷兰关节成形术登记处进行了联系。我们对KA/HA进行分层，手术后30天内首次出院阿片类药物被量化为吗啡毫克当量中位数(MME)。阿片类处方医生包括骨科医生、全科医生、风湿病医生、麻醉医生和其他内科医生。长期使用定义为术后90天后开出超过一张阿片类药物处方。我们使用线性和Logistic回归分析对混杂因素进行调整。

结果：70%的KA患者（46106例）及51%的HA患者（42893例）被开出了≥一张阿片类药物。羟考酮作为首次处方的阿片类药物次数增加(从44%增加到85%)，而曲马多的次数减少(64% - 11%)，但他们的剂量保持稳定(是处方人员首选的更强的阿片类药物)。每增加1%MME，总MME(KA/HA)分别增加0.43%/0.37%。首次处方的阿片类药物剂量增加100MME对长期使用的影响很小(患病率：25%KA，20%HA)(KA/HA的优势比分别为1.02/1.01)。2013至2018年间，骨科医生开出的首次处方增加(44% - 69%)。全科医生开出了更多的连续处方(>50%)。

结论：在2013年至2018年期间，羟考酮增加成为首次出院处方。首次处方阿片类药物的剂量与总剂量和延长使用风险的小幅增加有关。首次处方大多由骨科医生开出，而全科医生则开出了更多的连续处方。

原始文献来源：Heather E. van Brug, Rob G. H. H. Nelissen, Frits R. Rosendaal, et al. Out-of-hospital opioid prescriptions after knee and hip arthroplasty: prescribers and the first prescribed opioid. [J]Br J Anae 130 (4): 459-467 (2023), doi: 10.1016/j.bja.2022.12.024.

英文原文：

Out-of-hospital opioid prescriptions after knee and hip arthroplasty: prescribers and the first prescribed opioid

Abstract

Background: We determined the first prescribed opioid and the prescribers of opioids after knee and hip arthroplasty (KA/HA) between 2013 and 2018 in the Netherlands. We also evaluated whether the first prescribed opioid dose was associated with the total dispensed dose and long-term opioid use in the first postoperative year.

Method: The Dutch Foundation for Pharmaceutical Statistics was linked to the Dutch Arthroplasty Register. Stratified for KA/HA, the first out-of-hospital opioid within 30 days of operation was quantified as median morphine milligram equivalent (MME). Opioid prescribers were orthopaedic surgeons, general practitioners, rheumatologists, anaesthesiologists, and other physicians. Long-term use was defined as ≥1 opioid prescription for >90 postoperative days. We used linear and logistic regression analyses adjusted for confounders.

Results: Seventy percent of 46 106 KAs and 51% of the 42 893 HAs were prescribed ?1 opioid. Oxycodone increased as first prescribed opioid (from 44% to 85%) whereas tramadol decreased (64-11%), but their dosage remained stable (stronger opioids were preferred by prescribers). An increase in the first prescription of 1% MME resulted in a 0.43%/0.37% increase in total MME (KA/HA, respectively). A 100 MME increase in dose of the first dispensed opioid had a small effect on long-term use (prevalence: 25% KA, 20% HA) (odds ratio=1.02/1.01 for KA/HA, respectively). Orthopaedic surgeons increasingly prescribed the first prescription between 2013 and 2018 (44-69%). General practitioners mostly prescribed consecutive prescriptions (>50%).

Conclusion: Oxycodone increased as first out-of-hospital prescription between 2013 and 2018. The dose of the first prescribed opioid was associated with the total dose and a small increased risk of prolonged use. First prescriptions were mostly written by orthopaedic surgeons and consecutive prescriptions by general practitioners.

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