Pain Management After Outpatient Anterior Cruciate Ligament Reconstruction

Secrist, Eric; Freedman, Kevin B.; Ciccotti, Michael G.; Mazur, Donald; Hammoud, Sommer

doi:10.1177/0363546515617737

Cited by 114 publications

(103 citation statements)

References 124 publications

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“…Opioid use after orthropaedic surgery has been a significant issue [10,12,[13][14][15][16][17]19,21,22]. After ACLR acute pain management is routinely necessary.…”

Section: Discussionmentioning

confidence: 99%

“…We used intra-articular bupivacaine injections, compression cryotherapy and non-steroidal anti-inflammatory medication in the post-operative period. All of which have been shown to decrease opioid consumption after ACLR [15]. A complexity of our study could be in how we identified our three groups based on the amount of medication given or number of weekly prescriptions.…”

Section: Discussionmentioning

confidence: 99%

“…With an annual incidence of 68.6 per 100,000 person-years, isolated ACL tears remain a common orthopedic injury [11]. Pain management after ACLR has been studied to varying degrees [12][13][14][15][16][17]. Approximately three decades ago, ACLR was done on an inpatient basis.…”

Section: Introductionmentioning

confidence: 99%

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Limiting Opioid Prescription after Anterior Cruciate Ligament Reconstruction: A Study of 749 Consecutive Cases

Simonian¹,

Simonian²

2019

AOMD

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Purpose: We document the postoperative opioid use in 749 consecutive patients after Anterior Cruciate Ligament Reconstruction (ACLR). We define three groups of total postoperative opioid usage: 0-1 week, 1-2 weeks and greater than 3 weeks; and define characteristics correlated to each group. Postoperative opioid used was measured by the number of prescriptions given. Methods: Opioid was prescribed in quantities not to exceed a one-week supply. In Group 1, a single prescription of opioid converted to a maximum of 300-375 Morphine Milligram Equivalent (MME) or less(which is equivalent to hydrocodone 7.5 mg per tablet with a total number of 40-50 tablets or less). In Group 2, two prescriptions of opioid, converted to 376-750 MME. In Group 3, three prescriptions or more converted to 751 or greater MME. The following demographics and characteristics were identified for each group: age, gender, tobacco smoke, regular alcohol use, diabetes, anxiety or depression, worker's compensation, history of chemical dependence, and history of intravenous drug use. The following concomitant surgical procedures were identified for each group: menisectomy, chondroplasty, meniscal repair, and microfracture. Results: The great majority of patients, 634 (85%), were in Group 1 requiring no more than a single prescription, one week or less, of opioid. The 115 patients (15%) that exceeded the typical range of the Group 1 opioid requirement (Group 2 & 3) had a statistically significant (p<0.05) association with increased age, alcohol usage, tobacco smoking; anxiety or depression (Group 2 only); and concomitant microfracture. Conclusion: We recommend limiting the initial opioid prescription not to exceed a one-week supply or less (300-375 MME or less) after ACLR. This amount satisfied the opioid requirement for 85% of our patients undergoing primary allograft ACLR. In the last year of this study, opioid prescription did not exceed 300 MME and no opioid prescription exceeded forty tablets. Increased age, alcohol use, tobacco smoking, anxiety or depression and microfracture were significantly associated with increased opioid usage. Clinical Significance: This information should help leave fewer unused opioid in the possession of patients, leaving fewer pills vulnerable to misuse, abuse, and diversion. Another goal would be to use this information to help develop a postoperative pain management protocol or guidelines after ACLR.

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“…Opioid use after orthropaedic surgery has been a significant issue [10,12,[13][14][15][16][17]19,21,22]. After ACLR acute pain management is routinely necessary.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Limiting Opioid Prescription after Anterior Cruciate Ligament Reconstruction: A Study of 749 Consecutive Cases

Simonian¹,

Simonian²

2019

AOMD

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“…Postoperative pain control is not only essential for early exercise, return to normal life, improvement of respiratory capability, and reduced respiratory complications, but also for humane reasons, as it may reduce fear and anxiety ( 8 , 18 ).…”

Section: Discussionmentioning

confidence: 99%

Paracetamol Instead of Ketorolac in Post-Video-Assisted Thoracic Surgery Pain Management: A Randomized Trial

et al. 2016

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BackgroundVideo-assisted thoracic surgery (VATS) is a minimally invasive procedure that is growing more common around the world. Despite causing less pain compared open thoracic surgery, postoperative pain management is still important.ObjectivesThe aim of the present study was to compare the analgesic effects of paracetamol and ketorolac in VATS patients.MethodsThis was a double-blinded randomized clinical trial conducted on 70 patients undergoing lobectomy or segmentectomy due to lung masses, using video-assisted methods. The patients were randomly divided into two groups (each n = 35): the ketorolac (K) group and the paracetamol (P) group. The K group received ketorolac 30 mg IV stat at the end of surgery and then a 90 mg/24 h infusion. The P group received paracetamol 1 g IV stat at the end of surgery and then a 3 g/24 h infusion. Pain scores were recorded during recovery and 2, 4, 8, 12, and 24 hours after drug administration. Pain scores, total doses of rescue analgesics, and patient satisfaction levels were compared between the groups.ResultsThere was no significant difference between the K and P groups in pain scores in any of the evaluations. Seventeen (48.6 %) and 9 (25.7 %) patients in the K and P groups, respectively, did not require any rescue analgesia (P = 0.047). The mean doses of rescue analgesia in the K and P groups were 3.129 ± 4.27 mg and 4.38 ± 3.69 mg, respectively, which were similar (P = 0.144). There was no significant difference between the groups in satisfaction scores (P = 0.175).ConclusionsParacetamol 1 g stat + 3 g/24 h infusion is as effective as ketorolac 30 mg stat + 90 mg/24 h infusion in post-VATS pain management, with good tolerability and a low incidence of adverse effects.

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“…As well as these studies, there are also other studies comparing gabapentin's effects with other analgesic agents resulting in contradictory ideas. 15 It is known that the increased severity of surgery and magnitude of tissue injury are related with increases in the plasma levels of proinflammatory cytokines. 16 TNF-α and IL-6 are 2 early important features of acute injury that play a role in persistent postoperative pain syndromes.…”

mentioning

confidence: 99%

Does preemptive gabapentin modulate cytokine response in total knee arthroplasty? A placebo controlled study

Erkılıç¹,

Kesimci²,

Şahin³

et al. 2018

Adv Clin Exp Med

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Pain Management After Outpatient Anterior Cruciate Ligament Reconstruction

Abstract: These results provide the best available evidence from RCTs on pain control regimens after ACL reconstruction.

Cited by 114 publications

References 124 publications

Limiting Opioid Prescription after Anterior Cruciate Ligament Reconstruction: A Study of 749 Consecutive Cases

Limiting Opioid Prescription after Anterior Cruciate Ligament Reconstruction: A Study of 749 Consecutive Cases

Paracetamol Instead of Ketorolac in Post-Video-Assisted Thoracic Surgery Pain Management: A Randomized Trial

Does preemptive gabapentin modulate cytokine response in total knee arthroplasty? A placebo controlled study

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