Opioid Prescription and Usage in Adolescents Undergoing Orthopaedic Surgery in the United States

Dautremont, Erin A.; Ebramzadeh, Edward; Beck, Jennifer J.; Bowen, Richard E.; Sangiorgio, Sophia N.

doi:10.2106/jbjs.rvw.16.00093

Cited by 34 publications

(36 citation statements)

References 31 publications

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“…Reducing the amount of opioids prescribed to a cohort of post-operative ankle fracture patients was found to produce rates of disability and treatment satisfaction comparable to those of a cohort of patients prescribed a greater amount of opioids, suggesting that improvement in functional status may not be directly correlated with amount of opioids used after a certain threshold [11]. However, a correlation has been observed between the amount of opioids prescribed and various post-operative complications, further underscoring the need for improved prescribing practices [8,9].…”

Section: Resultsmentioning

confidence: 99%

Interdisciplinary Mitigation of Opioid Misuse in Musculoskeletal Patients

Saigal

Jones

2019

HSS Journal®

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Background: The opioid prescribing patterns of orthopedic surgeons have been shown to play a role in exacerbating rates of opioid misuse among postsurgical patients. Demonstrable success has been appreciated by combining policy-level approaches and clinical education-based strategies to inform patients of alternative modalities of post-operative analgesia. Questions/ Purposes: The purpose of this review was to address two questions: What are the most substantiated measures orthopedic surgeons can take to limit opioid misuse or addiction among their patients? What advantages are gained in orthopedic surgeons' collaborating with other healthcare professionals with influence over patients' post-operative opioid exposure? Methods: We searched two databases for articles on multidisciplinary policybased solutions to mitigating the opioid overdose crisis among musculoskeletal patients. Articles produced from the search were searched for further evidence supporting the use of standardized clinical and administrative protocols in mitigating opioid misuse within this patient population. Successful approaches to mitigating misuse of opioids in this demographic were synthesized from recurring themes in the studies. Results: Multiple articles support orthopedic surgeons being aware of the risk factors for chronic opioid use among their patients, as well as multidisciplinary strategies involving orthopedic surgeons and other healthcare/governmental professionals to address the burden of the opioid crisis on surgical patients. Conclusions: Addressing the misuse of opioids among orthopedic patients requires appropriate prescribing practices and long-term support of patients. Collaboration between surgeons and policymaking entities is recognized as an effective population-wide approach to preventing opioid dependence, misuse, and addiction. Keywords interdisciplinary. multilateral. opioid overdose crisis. post-operative pain management. orthopedic surgery. musculoskeletal patients. medico-legal collaboration. health policy. bioethics. anesthesia. nursing

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Section: Resultsmentioning

confidence: 99%

Interdisciplinary Mitigation of Opioid Misuse in Musculoskeletal Patients

Saigal

Jones

2019

HSS Journal®

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“…Several investigators recently have begun to explore the relationship between preoperative opiate use and postoperative outcomes. [20][21][22][23][24] In their investigation regarding opioid prescriptions in orthopaedic trauma patients, Holman et al 20 determined that preinjury opiate use is predictive of prolonged use post injury and predictive of patients who will seek opiates from other providers. Bedard et al 23 illustrated an identical trend in patients undergoing total knee arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Preoperative Opioid Usage in Hip Arthroscopy: A Comparison With Opioid-Naïve Patients

Zusmanovich

Thompson

Campbell

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The legitimate use of prescription opioids in high school seniors increases the risk of future misuse after high school by 33% [4]. The prescribing of opioids and the treatment of pain for adolescent orthopedic outpatient surgery remains unexplored [5].…”

Section: Introductionmentioning

confidence: 99%

Regional Anesthesia and the Adolescent Opioid Epidemic

2019

Medical &Amp; Clinical Research

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Rationale: The legitimate use of prescription opioids in high school seniors increases the risk of future misuse after high school by 33%. Medial patellofemoral ligament reconstruction (MPFLR) is an operation to correct recurrent patellar instability occurring primarily in teenagers with joint hyperlaxity. MPFLR is associated with the extensive use of prescription opioids for significant postoperative pain and prolonged recovery. The hypothesis of this study is that the addition of a single injection proximal sciatic nerve block would significantly reduce opioid requirements and pain scores in adolescents undergoing MPFLR with an adductor canal continuous peripheral nerve block (CPNB). Objectives: The primary end-point of the study is cumulative post-operative opioid consumption (mg/kg morphine equivalents) while hospitalized after MPFLR between the two groups. Findings: We retrospectively compared 25 patients who received an adductor canal CPNB with a single injection proximal sciatic nerve block (Group A/S) and 23 patients who received only an adductor canal CPNB (Group A). Morphine consumption was less than half in group A/S compared to Group A. Eighty-eight percent of patients in Group A/S did not require opioids on the DOS. Maximum and mean pain scores on DOS and POD 1 were significantly lower in Group A/S than Group A. Conclusions: This study suggests the addition of a proximal sciatic nerve block to the adductor canal CPNB significantly reduces opioid requirements and pain scores in the first 24-32 hours after MPFLR in adolescent patients and supports a randomized clinical trial to confirm these findings.

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Opioid Prescription and Usage in Adolescents Undergoing Orthopaedic Surgery in the United States

Abstract: There appear to be no studies on self-administered opioid pain medication following orthopaedic surgery in an adolescent population, suggesting that there is no objective basis for the current prescription recommendations.

Cited by 34 publications

References 31 publications

Interdisciplinary Mitigation of Opioid Misuse in Musculoskeletal Patients

Interdisciplinary Mitigation of Opioid Misuse in Musculoskeletal Patients

Outcomes of Preoperative Opioid Usage in Hip Arthroscopy: A Comparison With Opioid-Naïve Patients

Regional Anesthesia and the Adolescent Opioid Epidemic

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