Extra Opioid Remedy and Variation in Prescribing Patterns Following Widespread Orthopaedic Procedures.
J Bone Joint Surg Am. 2018 Feb 07;100(three):180-188
Authors: Sabatino MJ, Kunkel ST, Ramkumar DB, Keeney BJ, Jevsevar DS
BACKGROUND: Postoperative ache administration in orthopaedic surgical procedure accounts for a considerable portion of opioid drugs prescribed in the US. Understanding prescribing habits and affected person utilization of those drugs following a surgical process is important to establishing applicable prescribing protocols that successfully management ache whereas minimizing unused opioid distribution. We evaluated prescribing habits and affected person utilization following elective orthopaedic surgical procedures to establish methods of bettering postoperative opioid-prescribing practices.
METHODS: We carried out a evaluation of prescribing information of 1,199 procedures and gathered phone survey outcomes from 557 sufferers to find out the variety of opioid tablets prescribed postoperatively and the variety of unused tablets. The information have been collected from grownup sufferers who underwent 1 of the 5 commonest elective orthopaedic procedures at our establishment in fiscal yr 2015: complete hip arthroplasty, complete knee arthroplasty, endoscopic carpal tunnel launch, arthroscopic rotator cuff restore, or lumbar decompression. We transformed all dosages to opioid equivalents of oxycodone 5 mg and carried out analyses of prescribing patterns, affected person utilization, and affected person disposal of unused opioids.
RESULTS: Prescribing patterns following the 5 orthopaedic procedures confirmed large variation. The median numbers of oxycodone 5-mg equal opioid tablets prescribed upon discharge have been 90 tablets (vary, 20 to 330 tablets) for complete hip arthroplasty, 90 tablets (vary, 10 to 200 tablets) for complete knee arthroplasty, 20 tablets (vary, zero to 168 tablets) for endoscopic carpal tunnel launch, 80 tablets (vary, 18 to 100 tablets) for arthroscopic rotator cuff restore, and 80 tablets (vary, 10 to 270 tablets) for lumbar decompression. Thirty-seven p.c of sufferers general requested and obtained at the least 1 refill. The imply variety of complete tablets prescribed (and commonplace deviation) together with refills was 113.6 ± 75.7 for complete hip arthroplasty, 176.four ± 108.zero for complete knee arthroplasty, 24.three ± 29.zero for carpal tunnel launch, 98.2 ± 59.6 for rotator cuff restore, and 107.four ± 64.four for lumbar decompression. Contributors reported unused opioid remedy in 61% of circumstances. Throughout the research yr, >43,000 unused opioid tablets have been prescribed. Forty-one p.c of sufferers reported applicable disposal of unused opioid tablets.
CONCLUSIONS: Prescribing patterns differ extensively, and a considerable amount of opioid drugs stays unused following elective orthopaedic surgical procedures. Efficient prescribing protocols are wanted to restrict this supply of potential abuse and opioid diversion throughout the group.
PMID: 29406338 [PubMed – in process]