Prospective cohort study on clinical pharmacist involvement in the management of opioid use after orthopedic surgery under the enhanced recovery after surgery model
- VernacularTitle:加速康复外科模式下临床药师参与骨科术后阿片类药物使用管理的前瞻性队列研究
- Author:
Yumin YANG
1
;
Xiumin LI
1
;
Lu WANG
2
Author Information
1. Dept. of Pharmacy，Medical Supplies Center，Chinese PLA General Hospital，Beijing 100700，China
2. Dept.of Pharmacy，Baoding No.1 Central Hospital，Hebei Baoding 071000，China
- Publication Type:Journal Article
- Keywords:
opioid;
hip or knee arthroplasty;
enhanced recovery after surgery;
drug-related problems;
clinical pharmacist
- From:
China Pharmacy
2025;36(12):1505-1510
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To provide a reference for improving postoperative pain management outcomes， accelerating patient recovery， and ensuring the safe use of opioids. METHODS A prospective cohort study was conducted， in which patients undergoing elective hip or knee replacement in the Department of Orthopedics at Baoding No.1 Central Hospital （hereinafter referred to as “our hospital”） from November 2021 to November 2023 were randomly divided into control group and observation group using a random number table， with 178 cases in each group. Patients in the control group received postoperative pain management implemented by medical staff according to the clinical pathway for perioperative pain treatment. Patients in the observation group， under the enhanced recovery after surgery model， received postoperative pain management through a multidisciplinary collaborative team including clinical pharmacists. The occurrence and resolution of opioid-related drug-related problems （DRPs） were compared between the two groups， and the DRPs were classified and analyzed using the Pharmaceutical Care Network Europe Classification System （V9.1）. Postoperative pain scores， sleep quality scores， length of hospital stay， and incidence of adverse reactions were compared between the two groups. RESULTS A total of 162 opioid-related DRPs were identified in 2 groups， with 58 in the observation group （identified 52 patients） and 104 in the control group （identified 91 patients）， showing a statistically significant difference （P＜0.05）. The primary issue involved in the DRPs for both groups was therapeutic effectiveness. Clinical pharmacists in the observation group conducted 88 interventions for the identified 58 opioid-related DRPs， achieving an overall intervention success rate of 84.5%. The pain scores and sleep quality scores from postoperative day 1 to 7， the length of hospitalization for hip replacement， the average hospitalization duration， and the total incidence of opioid-related adverse reactions were all significantly lower or shorter in the observation group compared to the control group （P＜0.05）. Furthermore， the main time effect， time-group interaction effect for pain scores and sleep quality scores were statistically significant in both groups （P＜0.05）， indicating that the control group exhibited greater reductions in these scores and observation group exhibited more rapid improvements. CONCLUSIONS The full involvement of clinical pharmacists in postoperative pain management and opioid medication administration in the orthopedics department enables timely identification and intervention of DRPs， enhance postoperative analgesia efficacy， decrease adverse drug reactions， shorten hospital stays， and accelerate patient recovery.
