PDF(Pubmed)
Abstract：
BACKGROUND: A growing number of countries have reported sharp increases in the use and harm of opioid analgesics. High rates of new opioid initiation are observed in postoperative patients. In response, various tertiary care institutions have developed opioid exit plans (OEPs) to curb potential opioid-related harm.
METHODS: PubMed and Embase were systematically searched to identify, summarize, and compare the interventional elements of OEPs for postoperative patient populations published from January 1, 2000, to June 4, 2024. Two researchers independently screened the articles for eligibility following the PRISMA 2020 guidelines, extracted the data, and assessed the study quality and risk of bias. Data synthesis was performed for study characteristics, intervention details, efficacy, and development.
RESULTS: A total of 2,585 articles were screened, eight of which met the eligibility criteria. All studies were conducted in North America and focused on orthopedic surgery patients following total hip or knee arthroplasty (n = 5) or neurosurgery (n = 3). Most studies (n = 7) included a pre-post (n = 4) or randomized clinical design (n = 3). Three studies were of good quality, and none had a low risk of bias. The interventions varied and ranged from educational sessions (n = 1) to individualized tapering protocols (n = 4) or a combination of the two (n = 2). Key elements were instructions on how to anticipate patients\' postoperative need for opioid analgesics and tapering strategies based on 24-h predischarge opioid consumption. Six studies included efficacy as an endpoint in their analysis, of which four assessed statistical significance, with all four identifying that the OEPs were successful in reducing postoperative opioid use.
CONCLUSIONS: Despite differences in design and implementation, the identified OEPs suggest that they are efficacious in reducing outpatient opioid consumption. They provide a robust estimate of postoperative analgesic requirements and a rationale for tapering duration and rate. However, more rigorous studies are needed to evaluate their real-world effectiveness.
METHODS: PubMed and Embase were systematically searched to identify, summarize, and compare the interventional elements of OEPs for postoperative patient populations published from January 1, 2000, to June 4, 2024. Two researchers independently screened the articles for eligibility following the PRISMA 2020 guidelines, extracted the data, and assessed the study quality and risk of bias. Data synthesis was performed for study characteristics, intervention details, efficacy, and development.
RESULTS: A total of 2,585 articles were screened, eight of which met the eligibility criteria. All studies were conducted in North America and focused on orthopedic surgery patients following total hip or knee arthroplasty (n = 5) or neurosurgery (n = 3). Most studies (n = 7) included a pre-post (n = 4) or randomized clinical design (n = 3). Three studies were of good quality, and none had a low risk of bias. The interventions varied and ranged from educational sessions (n = 1) to individualized tapering protocols (n = 4) or a combination of the two (n = 2). Key elements were instructions on how to anticipate patients\' postoperative need for opioid analgesics and tapering strategies based on 24-h predischarge opioid consumption. Six studies included efficacy as an endpoint in their analysis, of which four assessed statistical significance, with all four identifying that the OEPs were successful in reducing postoperative opioid use.
CONCLUSIONS: Despite differences in design and implementation, the identified OEPs suggest that they are efficacious in reducing outpatient opioid consumption. They provide a robust estimate of postoperative analgesic requirements and a rationale for tapering duration and rate. However, more rigorous studies are needed to evaluate their real-world effectiveness.
摘要：
背景：越来越多的国家报告阿片类镇痛药的使用和危害急剧增加。在术后患者中观察到新阿片类药物的高发生率。作为回应,各三级医疗机构制定了阿片类药物退出计划(OEP),以遏制潜在的阿片类药物相关危害.
方法：系统搜索PubMed和Embase，总结，并比较了2000年1月1日至2024年6月4日发表的术后患者人群的OEP介入要素。两名研究人员根据PRISMA2020指南独立筛选了这些文章的资格，提取数据，并评估研究质量和偏倚风险。对研究特征进行了数据合成，干预细节，功效,和发展。
结果：共筛选了2,585篇文章，其中八个符合资格标准。所有研究均在北美进行，重点是全髋关节或膝关节置换术（n=5）或神经外科（n=3）后的骨科手术患者。大多数研究（n=7）包括pre-post（n=4）或随机临床设计（n=3）。三项研究质量很好，没有一个有偏见的风险很低。干预措施各不相同，范围从教育课程（n=1）到个性化的锥形协议（n=4）或两者的组合（n=2）。关键要素是关于如何预测患者术后对阿片类镇痛药的需求以及基于24小时出院前阿片类药物消耗的逐渐减少策略的说明。六项研究将疗效作为其分析的终点，其中四个评估了统计学意义，4人都确认OEP成功减少了术后阿片类药物的使用.
结论：尽管在设计和实现方面存在差异，经鉴定的OEP表明,它们可有效减少门诊阿片类药物的消耗.它们提供了术后镇痛需求的可靠估计以及逐渐减少持续时间和速率的基本原理。然而,需要更严格的研究来评估它们在现实世界中的有效性。
方法：系统搜索PubMed和Embase，总结，并比较了2000年1月1日至2024年6月4日发表的术后患者人群的OEP介入要素。两名研究人员根据PRISMA2020指南独立筛选了这些文章的资格，提取数据，并评估研究质量和偏倚风险。对研究特征进行了数据合成，干预细节，功效,和发展。
结果：共筛选了2,585篇文章，其中八个符合资格标准。所有研究均在北美进行，重点是全髋关节或膝关节置换术（n=5）或神经外科（n=3）后的骨科手术患者。大多数研究（n=7）包括pre-post（n=4）或随机临床设计（n=3）。三项研究质量很好，没有一个有偏见的风险很低。干预措施各不相同，范围从教育课程（n=1）到个性化的锥形协议（n=4）或两者的组合（n=2）。关键要素是关于如何预测患者术后对阿片类镇痛药的需求以及基于24小时出院前阿片类药物消耗的逐渐减少策略的说明。六项研究将疗效作为其分析的终点，其中四个评估了统计学意义，4人都确认OEP成功减少了术后阿片类药物的使用.
结论：尽管在设计和实现方面存在差异，经鉴定的OEP表明,它们可有效减少门诊阿片类药物的消耗.它们提供了术后镇痛需求的可靠估计以及逐渐减少持续时间和速率的基本原理。然而,需要更严格的研究来评估它们在现实世界中的有效性。
