Editorial Commentary: Opioid Sparing Through Patient Education Programs Is the Future for Sports Medicine and Arthroscopic Surgery to Optimize Outcome

Rossi, Michael J.

doi:10.1016/j.arthro.2021.02.029

Cited by 2 publications

(2 citation statements)

References 46 publications

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“…Patient education has been recognized as an important pillar in postoperative opioid reduction and pain control across surgical domains . Within the arthroscopy literature, there is growing evidence to suggest that patient education may reduce both short-term and long-term postoperative opioid use …”

Section: Discussionmentioning

confidence: 99%

Effect of a Postoperative Multimodal Opioid-Sparing Protocol vs Standard Opioid Prescribing on Postoperative Opioid Consumption After Knee or Shoulder Arthroscopy

Gazendam

Ekhtiari

Horner

et al. 2022

JAMA

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ImportanceIn arthroscopic knee and shoulder surgery, there is growing evidence that opioid-sparing protocols may reduce postoperative opioid consumption while adequately addressing patients’ pain. However, there are a lack of prospective, comparative trials evaluating their effectiveness.ObjectiveTo 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.Design, Setting, and ParticipantsThis 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.InterventionsThe 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.Main Outcomes and MeasuresThe 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.ResultsAmong 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; z = −6.55; P &lt; .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; P &lt; .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%, P = .048).Conclusions and RelevanceAmong 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.Trial RegistrationClinicalTrials.gov Identifier: NCT04566250

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Section: Discussionmentioning

confidence: 99%

Effect of a Postoperative Multimodal Opioid-Sparing Protocol vs Standard Opioid Prescribing on Postoperative Opioid Consumption After Knee or Shoulder Arthroscopy

Gazendam

Ekhtiari

Horner

et al. 2022

JAMA

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“…The interesting difference was that this protocol included an educational component for patients in the opioid‐sparing group on pharmacologic and nonpharmacologic pain management strategies, and the risks associated with misuse of opioids. It seems that patient education on postoperative opioid consumption may play a more significant part in reducing opioid use, rather than the adjunctive medications prescribed [20, 25].…”

Section: Discussionmentioning

confidence: 99%

Multimodal analgesia did not improve post-operative pain scores, reduce opioid consumption or reduce length of stay following hip arthroscopy

Degen

Firth

Sehmbi

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeTo determine whether different regimens of multimodal analgesia will reduce postoperative pain scores, opioid consumption, costs and hospital length‐of‐stay following hip arthroscopy. MethodsFrom 2018 to 2021, 132 patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) were included in this prospective, single‐center randomized controlled trial. Patients were randomized into four treatment groups: Group 1—Control: opioid medication (oxycodone‐acetaminophen 5 mg/325 mg, 1–2 tabs q6H as needed), Heterotopic ossification prophylaxis—Naprosyn 500 mg twice daily × 3 weeks); Group 2—Control + postoperative sleeping aid (Zopiclone 7.5 mg nightly × 7 days); Group 3—Control + preoperative and postoperative Gabapentin (600 mg orally, 1 h preoperatively; 600 mg postoperatively, 8 h following pre‐op dose); Group 4—Control + pre‐medicate with Celecoxib (400 mg orally, 1 h preoperatively) The primary outcome was pain measured with a visual analog scale, monitored daily for the first week and every other day for 6 weeks. Secondary outcomes included opioid consumption, healthcare resource use, and hospital length of stay. ResultsPatient characteristics were similar between groups. There were no statistically significant differences in pain scores between groups at any timepoint after adjusting for intra‐operative traction time, intra‐operative opioid administration and preoperative pain scores (p > 0.05). There were also no significant differences in the number of days that opioids were taken (n.s.) and the average daily morphine milligram equivalents consumed (n.s.). Similarly, there were no statistically significant differences in length of stay in the experimental groups, compared with the control group (n.s.). Finally, there were no differences in cost between groups (n.s.). ConclusionThe routine use of Zopiclone, Celecoxib and Gabapentin did not improve postoperative pain control or reduce length‐of‐stay following hip arthroscopy. Therefore, these medications are not recommended for routine postoperative pain control following hip arthroscopy. Level of evidencel.

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Editorial Commentary: Opioid Sparing Through Patient Education Programs Is the Future for Sports Medicine and Arthroscopic Surgery to Optimize Outcome

Cited by 2 publications

References 46 publications

Effect of a Postoperative Multimodal Opioid-Sparing Protocol vs Standard Opioid Prescribing on Postoperative Opioid Consumption After Knee or Shoulder Arthroscopy

Effect of a Postoperative Multimodal Opioid-Sparing Protocol vs Standard Opioid Prescribing on Postoperative Opioid Consumption After Knee or Shoulder Arthroscopy

Multimodal analgesia did not improve post-operative pain scores, reduce opioid consumption or reduce length of stay following hip arthroscopy

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