{"id":22885,"date":"2022-10-24T04:39:00","date_gmt":"2022-10-23T20:39:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=22885"},"modified":"2022-10-24T08:07:38","modified_gmt":"2022-10-24T00:07:38","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e8%86%9d%e6%88%96%e8%82%a9%e5%85%b3%e8%8a%82%e9%95%9c%e6%9c%af%e5%90%8e%e4%b8%8d%e7%94%a8%e9%98%bf%e7%89%87%e7%b1%bb%e8%8d%af%e7%89%a9%e7%9a%84","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=22885","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u819d\u6216\u80a9\u5173\u8282\u955c\u672f\u540e\u4e0d\u7528\u963f\u7247\u7c7b\u836f\u7269\u7684\u591a\u6a21\u6001\u65b9\u6848\u4e0e\u6807\u51c6\u963f\u7247\u7c7b\u836f\u7269\u6cbb\u7597\u5bf9\u672f\u540e\u963f\u7247\u7528\u91cf\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

October 4, 2022<\/p>\n\n\n\n

Effect of a Postoperative Multimodal Opioid-Sparing Protocol vs Standard Opioid Prescribing on Postoperative Opioid Consumption After Knee or Shoulder Arthroscopy: A Randomized Clinical Trial<\/h1>\n\n\n\n

The NO PAin Investigators<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>2022;328(13):1326-1335. doi:10.1001\/jama.2022.16844<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Does a multimodal opioid-sparing postoperative pain protocol reduce postoperative opioid consumption compared with standard opioid prescribing after arthroscopic knee or shoulder surgery?<\/p>\n\n\n\n

Findings<\/strong>  In this randomized clinical trial that included 200 patients, a multimodal opioid-sparing postoperative pain protocol, compared with standard opioid prescribing, significantly reduced postoperative opioid consumption over 6 weeks (median oral morphine equivalent consumption, 0 mg vs 40 mg, respectively).<\/p>\n\n\n\n

Meaning<\/strong>  Among patients who underwent arthroscopic knee or shoulder surgery, a multimodal opioid-sparing postoperative pain management protocol significantly reduced postoperative opioid consumption compared with standard opioid prescribing.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  In arthroscopic knee and shoulder surgery, there is growing evidence that opioid-sparing protocols may reduce postoperative opioid consumption while adequately addressing patients\u2019 pain. However, there are a lack of prospective, comparative trials evaluating their effectiveness.<\/p>\n\n\n\n

Objective<\/strong>  To evaluate the effect of a multimodal, opioid-sparing approach to postoperative pain management compared with the current standard of care in patients undergoing arthroscopic shoulder or knee surgery.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This randomized clinical trial was performed at 3 clinical sites in Ontario, Canada, and enrolled 200 patients from March 2021 to March 2022 with final follow-up completed in April 2022. Adult patients undergoing outpatient arthroscopic shoulder or knee surgery were followed up for 6 weeks postoperatively.<\/p>\n\n\n\n

Interventions<\/strong>  The opioid-sparing group (100 participants randomized) received a prescription of naproxen, acetaminophen (paracetamol), and pantoprazole; a limited rescue prescription of hydromorphone; and a patient educational infographic. The control group (100 participants randomized) received the current standard of care determined by the treating surgeon, which consisted of an opioid analgesic.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was postoperative oral morphine equivalent (OME) consumption at 6 weeks after surgery. There were 5 secondary outcomes, including pain, patient satisfaction, opioid refills, quantity of OMEs prescribed at the time of hospital discharge, and adverse events at 6 weeks all reported at 6 weeks after surgery.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among the 200 patients who were randomized (mean age, 43 years; 73 women [38%]), 193 patients (97%) completed the trial; 98 of whom were randomized to receive standard care and 95 the opioid-sparing protocol. Patients in the opioid-sparing protocol consumed significantly fewer opioids (median, 0 mg; IQR, 0-8.0 mg) than patients in the control group (median, 40.0 mg; IQR, 7.5-105.0;\u00a0z<\/em>\u2009=\u2009\u22126.55;\u00a0P<\/em>\u2009<\u2009.001). Of the 5 prespecified secondary end points, 4 showed no significant difference. The mean amount of OMEs prescribed was 341.2 mg (95% CI, 310.2-372.2) in the standard care group and 40.4 mg (95% CI, 39.6-41.2) in the opioid-sparing group (mean difference, 300.8 mg; 95% CI, 269.4-332.3;\u00a0P<\/em>\u2009<\u2009.001). There was no significant difference in adverse events at 6 weeks (2 events [2.1%] in the standard care group vs 3 events [3.2%] in the opioid-sparing group), but more patients reported medication-related adverse effects in the standard care group (32% vs 19%,\u00a0P<\/em>\u2009=\u2009.048).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Among patients who underwent arthroscopic knee or shoulder surgery, a multimodal opioid-sparing postoperative pain management protocol, compared with standard opioid prescribing, significantly reduced postoperative opioid consumption over 6 weeks.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT04566250<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  October 4, 2022 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22885"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=22885"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22885\/revisions"}],"predecessor-version":[{"id":22886,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22885\/revisions\/22886"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=22885"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=22885"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=22885"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}