Multimodal Nonopioid Pain Protocol Provides Equivalent Pain Versus Opioid Control Following Meniscus Surgery: A Prospective Randomized Controlled Trial

Jildeh, Toufic R.; Okoroha, Kelechi R.; Kuhlmann, N; Cross, Austin G.; Abbas, Muhammad J.; Moutzouros, Vasilios

doi:10.1016/j.arthro.2021.02.043

Cited by 15 publications

(10 citation statements)

References 19 publications

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“…There is evidence that widely available, over-the-counter nonopioid medications can significantly reduce opioid consumption after arthroscopic surgery . However, the current literature is limited to small sample sizes, narrow patient populations, ineffective strategies, or complex postoperative protocols that include medications with significant adverse effect profiles . Given the common nature of these procedures and evidence of excessive opioid prescribing and utilization, an effective, pragmatic, opioid-sparing postoperative analgesic protocol would be important to develop.…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…reviewed the selected hits (15 publications from 11 panel members) for relevance. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] To gain insight into the possible preferences for surgical approach, all publications of the panel members on the shoulder impingement subject, without time restriction, were also scored for this outcome. In cases of disagreement, assessment by a third reviewer (E.J.D.V.)…”

Section: Consensus Statement For Shoulder Impingement: Tomentioning

confidence: 99%

“…was decisive. Seven articles were considered relevant 7,[13][14][15]17,19,20 (and 8 were not [8][9][10][11][12]16,18,21 ). Of all articles related to shoulder impingement, 10 were scored as "in favor of surgery" [10][11][12][13][14][15][16][17]19,20 ; none, "not in favor of surgery"; and 5, "inconclusive."…”

Section: Consensus Statement For Shoulder Impingement: Tomentioning

confidence: 99%

“…Seven articles were considered relevant 7,[13][14][15]17,19,20 (and 8 were not [8][9][10][11][12]16,18,21 ). Of all articles related to shoulder impingement, 10 were scored as "in favor of surgery" [10][11][12][13][14][15][16][17]19,20 ; none, "not in favor of surgery"; and 5, "inconclusive." [7][8][9]18,21 In contrast, of the 90 authors of systematic reviews (or studies included in these reviews) referred to in the consensus article, just 1 (G.A.)…”

Section: Consensus Statement For Shoulder Impingement: Tomentioning

confidence: 99%

“…With over 350 patients between studies treated with this regimen, we have demonstrated an equivalent side effect profile between our nonnarcotic regimen and opioids, for a variety of surgeries. 1,2,[15][16][17] There have been no major complications such as visual disturbance, and sedation has been noted to be the most common side effect.…”

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Author Reply to “Published Multimodal Anesthetic Protocols Using Gabapentin Risk Substantial Side Effects and Are Not Recommended”

Jildeh

Okoroha

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Patient Satisfaction with Nonopioid Postoperative Analgesia in Head and Neck Surgery: A Prospective Randomized Trial

Perez,

Pannu,

Frank

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveTo evaluate patients' satisfaction with opioid versus opioid‐sparing postoperative analgesia in patients undergoing outpatient head and neck surgery.Study DesignProspective randomized trial.SettingTertiary care academic hospital.MethodsAdult patients undergoing outpatient head and neck surgery were randomly assigned to 1 of 3 analgesic regimens. First‐ and second‐line medications were the following by group (1) Hydrocodone‐acetaminophen with ibuprofen, (2) ibuprofen with hydrocodone‐acetaminophen, and (3) ibuprofen with acetaminophen. Preoperative counseling was provided to patients regarding expected pain and proper medication use. Postoperative questionnaires were administered to assess satisfaction.ResultsOne hundred three patients were enrolled in the study (mean age, 56.5 years; women, 75 [73%]). The mean satisfaction score with the pain regimen assigned was similar between the 3 groups (scale 0‐10, [7.7, 8.3, 8.5, P = .46]). A similar percentage of patients in each group reported that surgery was more painful than anticipated (25%, 32%, 26%, P = .978), and a similar percentage of patients reported willingness to utilize the same analgesic regimen following future surgeries (75%, 83%, 76%, P = .682). Additional questions evaluating the side effect profile, maximum and minimum pain scores, and difficulty of recovery were not statistically different between the 3 groups.ConclusionIn the postoperative population for outpatient head and neck surgeries, there was no significant difference in patient satisfaction and pain control between the opioid and nonopioid arms. Providers should discuss opioid‐sparing regimens preoperatively with patients and describe them as effective in providing adequate pain control without a significant impact on patient's perception of care.

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Multimodal Nonopioid Pain Protocol Provides Equivalent Pain Versus Opioid Control Following Meniscus Surgery: A Prospective Randomized Controlled Trial

Cited by 15 publications

References 19 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

Author Reply to “Published Multimodal Anesthetic Protocols Using Gabapentin Risk Substantial Side Effects and Are Not Recommended”

Patient Satisfaction with Nonopioid Postoperative Analgesia in Head and Neck Surgery: A Prospective Randomized Trial

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