Perioperative nonopioid analgesia reduces postoperative opioid consumption in knee arthroscopy: a systematic review and meta-analysis

Abstract

PurposeThe opioid epidemic has prompted an emphasis on investigating opioid‐sparing alternatives for pain management following knee arthroscopy. This review evaluated the effects of perioperative nonopioid adjunct analgesia on postoperative opioid consumption and pain control in patients undergoing knee arthroscopy. MethodsA systematic review and meta‐analysis was performed using the following databases: PubMed, Embase, Web of Science, MEDLINE, and SCOPUS. Prospective comparative studies assessing the efficacy of various perioperative nonopioid analgesic strategies in patients undergoing knee arthroscopy were included. Twenty‐five studies (n = 2408) were included. ResultsPre‐emptive nonopioid pain medications demonstrated a reduction in cumulative postoperative oral morphine equivalent (OME) consumption by 11.8 mg (95% CI − 18.3, − 5.4, p ≤ 0.0001) and VAS pain scores by 1.5 (95% CI − 2.3, − 0.7, p < 0.001) at 24 h compared to placebo. Postoperative nonopioid pain medications significantly reduced cumulative postoperative OME consumption by 9.7 mg (95% CI − 14.4, − 5.1, p < 0.001) and VAS pain scores by 1.0 (95% CI − 1.354, − 0.633, p < 0.001) at 24 h compared to placebo. Saphenous nerve blocks significantly reduced cumulative postoperative OME consumption by 6.5 mg (95% CI − 10.3, − 2.6, p = 0.01) and VAS pain scores by 0.8 (− 1.4, − 0.3, p = 0.03) at 24 h compared to placebo. Both preoperative patient education and postoperative cryotherapy reduced postoperative opioid consumption. ConclusionPerioperative nonopioid pharmacotherapy, saphenous nerve blocks, and cryotherapy for patients undergoing knee arthroscopy significantly reduce opioid consumption and pain scores when compared to placebo at 24 h postoperatively. These interventions should be considered in efforts to reduce opioid consumption in patients undergoing knee arthroscopy. More research is needed to determine which interventions can reduce pain outside of the immediate postoperative period and the potential synergistic effects of combining interventions. Level of evidenceII.

Protocol for a multicenter randomized controlled trial comparing a non-opioid prescription to the standard of care for pain control following arthroscopic knee and shoulder surgery

“…Importantly, it is a recognition of the fact that as more orthopaedic surgery patients are discharged home on the day of their surgery, or shortly thereafter, there needs to be a greater focus on patients' analgesic protocols after discharge [29]. The majority of opioid reduction studies in orthopaedic surgery and arthroscopy are focused on the immediate peri-operative time period, and the majority of interventions occur while patients are in hospital [30]. While such measures represent an important way to minimize patient pain and opioid usage while in hospital, the impact on post-hospital pain and opioid utilization is less clear.…”

Motor-sparing peripatellar plexus block provides noninferior block duration and complete block area of the peripatellar region compared with femoral nerve block: a randomized, controlled, noninferiority study

“…Perioperative analgesia for knee surgeries including total knee arthroplasty (TKA), knee arthroscopy, patellar surgery, and superficial knee surgery, remains difficult to manage [1][2][3]. Peripheral nerve block is a common method used to achieve pain control after knee surgeries [1], among which femoral nerve (FN) block is classically used for postoperative analgesia [2][3][4].…”

“…Perioperative analgesia for knee surgeries including total knee arthroplasty (TKA), knee arthroscopy, patellar surgery, and superficial knee surgery, remains difficult to manage [1][2][3]. Peripheral nerve block is a common method used to achieve pain control after knee surgeries [1], among which femoral nerve (FN) block is classically used for postoperative analgesia [2][3][4]. However, FN block alone only provides sensation to the anteromedial aspect of the knee [5], and quadriceps inhibition caused by FN block will increase the incidence of postoperative complications and prolong the hospital stay.…”

Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience

“…269 For simple arthroscopic procedures, cryotherapy post-operatively has been shown to decrease 24-h opioid consumption and pain scores compared to placebo. 270 Consensus Points for Knee Arthroscopy…”