Opioid Use After Knee Arthroscopy

Kamdar, Parth; Mandava, Nikhil K.; Narula, Aastha; Patel, Pushpendra; Vadasdi, Katherine B.; Greene, R. Timothy; Alberta, Frank G.

doi:10.1016/j.asmr.2019.11.003

Cited by 7 publications

(5 citation statements)

References 12 publications

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“…In this study, ACLR and hip labral repairs required a substantially larger amount of postoperative MMEs relative to shoulder labral repairs, which required significantly greater MMEs than meniscal procedures. This has been borne out in the literature 14,17,29,30,32 and makes intuitive sense as more invasive procedures requiring bony manipulation should necessitate higher opioid requirements. Despite the procedural differences in postoperative opioid requirements (ie, ACLR requiring higher MMEs than diagnostic arthroscopy), the amount of opioid utilization reported after the same group of procedures (ie, shoulder arthroscopy, knee arthroscopy) is not uniform in the literature.…”

Section: Discussionmentioning

confidence: 99%

“… 30 Sheth et al 32 systematically reviewed 8 studies on opioid use after arthroscopic procedures, concluding that up to 60% of prescribed opioids remained unused after arthroscopic procedures of the shoulder, knee, and hip. Kamdar et al 17 demonstrated that 90% of patients undergoing meniscal procedures consumed ≤5 pills postoperatively and nearly 60% of patients did not even consume any opioids. Despite these findings, an expert panel has provided recommendations for prescription of as many as 30 opioid pills after simple knee arthroscopy, 36 and some researchers reported mean opioid prescriptions of >50 opioid pills after arthroscopic shoulder procedures before an institutional opioid-reduction initiative.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Opioid Usage and Disposal Strategies After Arthroscopic Procedures in a Young Cohort: A Prospective Observational Study

Johns,

Johnson,

Brutico

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Although several studies have noted that patients are routinely overprescribed opioids, few have reported usage after arthroscopic surgery. Purpose: To determine opioid consumption and allocation for unused opioids after common arthroscopic surgeries. Study Design: Case series; Level of evidence, 4. Methods: Patients between the ages of 15 and 40 years who were scheduled to undergo anterior cruciate ligament reconstruction (ACLR), labral repair of the hip or shoulder, meniscectomy, or meniscal repair were prospectively enrolled. Patients were prescribed either 5 mg hydrocodone-325 mg acetaminophen or 5 mg oxycodone-325 mg acetaminophen based on surgeon preference. Patients completed a daily opioid usage survey during the 2-week postoperative period. In addition, patients completed a survey on postoperative day 21 inquiring about continued opioid use and medication disposal, if applicable. Opioid medication consumption was converted to morphine milligram equivalents (MMEs). Results: Of the 200 patients who were enrolled in the study, 176 patients had sufficient follow-up after undergoing 85 (48%) ACLR, 26 (14.8%) hip labral repair, 34 (19.3%) shoulder labral repair, 18 (10.2%) meniscectomy, and 13 (7.4%) meniscal repair procedures. Mean age was 26.1 years (SD, 7.38); surgeons prescribed a mean of 26.6 pills whereas patients reported consuming a mean of 15.5 pills. The mean MME consumption in the 14 days after each procedure was calculated: ACLR (95.7; 44% of prescription), hip labral repair (84.8; 37%), shoulder labral repair (57.2; 35%), meniscectomy (18.4; 27%), and meniscal repair (32.1; 42%). This corresponded to approximately 39% of the total opioid prescription being utilized across all procedures. Mean MME consumption was greatest on postoperative day 1 in hip, shoulder, and meniscal procedures and on postoperative day 2 in ACLR. Only 7.04% of patients reported continued opioid use in the third postoperative week. Patients had a mean of 11 unused pills or 77.7 MMEs remaining. Of the patients with remaining medication, 24.7% intended to keep their medication for future use. Conclusion: The results of our study indicate that patients who undergo the aforementioned arthroscopic procedures consume <75 MMEs in the 2-week postoperative period, translating into a mean of 10 to 15 pills consumed. Approximately 60% of total opioids prescribed went unused, and one-fourth of patients intended to keep their remaining medication for future usage. We have provided general prescribing guidelines and recommend that surgeons carefully consider customizing their opioid prescriptions on the basis of procedure site to balance optimal postoperative analgesia with avoidance of dissemination of excess opioids.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Postoperative Opioid Usage and Disposal Strategies After Arthroscopic Procedures in a Young Cohort: A Prospective Observational Study

Johns,

Johnson,

Brutico

et al. 2024

Orthopaedic Journal of Sports Medicine

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“…The relationship between age and sex as risk factors for greater postoperative pain, opioid usage, and subsequent risk of misuse and dependence has been conflicting 20,24,25 This study must be considered with respect to its limitations. First, there was the potential for confounding factors such as concomitant meniscal procedures 28 , graft selection for reconstruction, patient resilience or grit, and presence of coexisting psychiatric disorders that could impact patient postoperative pain, opioid consumption, and overall satisfaction. Such confounders are inherent limitations of studies of this nature and, although these factors were not directly accounted for, adequate study randomization should have minimized the effect of these confounding variables.…”

Section: Table II Mme Consumptionmentioning

confidence: 99%

Lower Opioid Prescription Quantity Does Not Negatively Impact Pain Control or Patient Satisfaction After ACL Reconstruction

Johns,

Hanna,

Destine

et al. 2024

Journal of Bone and Joint Surgery

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Background: The purpose of this study was to evaluate the effects of different quantities of prescribed opioid tablets on patient opioid utilization, postoperative pain and function, and satisfaction after anterior cruciate ligament reconstruction (ACLR). Methods: This was a prospective, randomized trial enrolling patients undergoing primary ACLR. Patients were assigned to 1 of 3 prescription groups: 15, 25, or 35 tablets containing 5-mg oxycodone. Patients completed visual analog scale (VAS) pain and medication logs, opioid medication satisfaction surveys, and International Knee Documentation Committee (IKDC) questionnaires postoperatively. Results: Among the 180 patients included in the analysis, there was no significant difference in VAS pain scores (p > 0.05), IKDC scores (p > 0.05), morphine milligram equivalents (MMEs) (p = 0.510) consumed, or patient satisfaction with regard to pain control (p = 0.376) between treatment groups. Seventy-two percent of opioids were consumed in the first 3 days postoperatively, and 83% of patients in the 15-tablet cohort felt that they received the “right amount” of or even “too many” opioids. Conclusions: The prescription of 15 opioid tablets resulted in equivalent pain control, patient satisfaction, and short-term functional outcomes as prescriptions of 25 or 35 opioid tablets after ACLR. Lower prescription quantities of opioid medication may provide equivalent postoperative pain and help to minimize the number of unused opioid doses at risk for possible diversion after ACLR. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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“…Despite high awareness of the opioid epidemic, clinicians still overprescribe opioids after surgery. [1][2][3][4][5][6][7] This postoperative overprescribing puts both patients and communities at risk, increasing the patient's likelihood of developing chronic opioid use [8][9][10][11][12][13][14] or opioidinduced ventilatory impairment 11 and adding to the reservoir of unused opioids available for misuse and diversion. 11 15 The discrepancy between clinicians' awareness of the opioid epidemic and the degree of overprescribing-over half of opioid pills prescribed after surgery go unused 7 suggests that prescribing practices are not based on purely rational decisions.…”

Section: Introduction Backgroundmentioning

confidence: 99%

“…Despite high awareness of the opioid epidemic, clinicians still overprescribe opioids after surgery 1–7. This postoperative overprescribing puts both patients and communities at risk, increasing the patient’s likelihood of developing chronic opioid use8–14 or opioid-induced ventilatory impairment11 and adding to the reservoir of unused opioids available for misuse and diversion 11 15…”

Section: Introductionmentioning

confidence: 99%

Evaluating the effectiveness of email-based nudges to reduce postoperative opioid prescribing: study protocol of a randomised controlled trial

et al. 2022

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IntroductionSurgical patients are commonly prescribed more opioids at discharge than needed to manage their postoperative pain. These excess opioids increase the risks of new persistent opioid use, opioid-induced ventilatory impairment and opioid diversion. This study tests the effectiveness of two behavioural nudges, one based on peer behaviour and one based on best practice guidelines, in reducing excessive postoperative opioid prescriptions.Methods and analysisThe study will be conducted at 19 hospitals within a large healthcare delivery system in northern California, USA. Three surgical specialties (general surgery, orthopaedic surgery and obstetric/gynaecological surgery) at each hospital will be randomised either to a control group or to one of two active intervention arms. One intervention is grounded in the theory of injunctive norms, and provides feedback to surgeons on their postoperative opioid prescribing relative to prescribing guidelines endorsed by their institution. The other intervention draws from the theory of descriptive norms, and provides feedback similar to the first intervention but using peers’ behaviour rather than guidelines as the benchmark for the surgeon’s prescribing behaviour. The interventions will be delivered by a monthly email. Both interventions will be active for twelve months. The effects of each intervention relative to the control group and to each other will be tested using a four-level hierarchical model adjusted for multiple hypothesis testing.Ethics and disseminationUsing behavioural nudges rather than rigid policy changes allows us to target excessive prescribing without preventing clinicians from using their clinical judgement to address patient pain. All study activities have been approved by the RAND Human Subjects Protection Committee (ID 2018-0988). Findings will be disseminated through conference presentations, peer-reviewed publications and social media accounts.Trial registration numberNCT05070338.

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Opioid Use After Knee Arthroscopy

Cited by 7 publications

References 12 publications

Postoperative Opioid Usage and Disposal Strategies After Arthroscopic Procedures in a Young Cohort: A Prospective Observational Study

Postoperative Opioid Usage and Disposal Strategies After Arthroscopic Procedures in a Young Cohort: A Prospective Observational Study

Lower Opioid Prescription Quantity Does Not Negatively Impact Pain Control or Patient Satisfaction After ACL Reconstruction

Evaluating the effectiveness of email-based nudges to reduce postoperative opioid prescribing: study protocol of a randomised controlled trial

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