The effect of preoperative education on opioid consumption in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial—2-year follow-up

Cheesman, Quincy T.; DeFrance, Michael; Stenson, James F.; Weekes, Danielle; Feldman, Jenna; Abboud, Joseph A.; Austin, Luke

doi:10.1016/j.jse.2020.04.036

Cited by 19 publications

(32 citation statements)

References 17 publications

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“…The key characteristics of the 66 included studies [ 5 , 50 – 114 ] are detailed in Table 1 : Study Characteristics, Description of Strategies and Outcomes. Most studies used a retrospective cohort ( n = 35) [ 5 , 52 , 56 , 60 , 72 – 74 , 78 – 89 , 91 – 94 , 97 – 99 , 101 – 105 , 108 , 109 , 111 , 112 ], a randomized controlled trial (RCT) ( n = 24) [ 50 , 51 , 53 – 55 , 57 , 59 , 61 , 62 , 65 – 71 , 75 , 76 , 95 , 100 , 106 , 107 , 113 , 114 ] or a prospective cohort ( n = 7) [ 58 , 63 , 64 , 77 , 90 , 96 , 110 ] design. Almost all the studies were conducted in the U.S. ( n = 58) [ 5 , 50 – 57 , 59 – 61 , 63 , 67 – 74 , 77 – 99 , 101 – 114 ].…”

Section: Resultsmentioning

confidence: 99%

“…Risk factors for chronic opioid use (e.g., previous opioid use, benzodiazepine use, substance abuse, mental health disorder, chronic pain) were measured in close to 70% of studies [ 5 , 50 , 51 , 56 – 58 , 61 , 63 , 64 , 67 , 68 , 72 – 74 , 78 , 79 , 82 – 89 , 92 – 95 , 97 – 100 , 102 – 114 ] (Supplemental Digital File 4 : Risk factors for chronic opioid use in included studies by types of strategies). The main risk factors involved were depression/anxiety or associated medication use [ 51 , 53 , 56 , 57 , 63 , 64 , 72 – 74 , 78 , 79 , 82 , 83 , 85 – 89 , 92 , 97 , 100 , 102 , 104 , 107 , 109 , 112 , 114 ], and prior opioid use [ 5 , 53 , 57 , 58 , 61 , 63 , 64 , 67 , 68 , 73 , 74 , 78 , 82 , 83 , 85 – 89 , 95 , 97 –…”

Section: Resultsmentioning

confidence: 99%

“…The main risk factors involved were depression/anxiety or associated medication use [ 51 , 53 , 56 , 57 , 63 , 64 , 72 – 74 , 78 , 79 , 82 , 83 , 85 – 89 , 92 , 97 , 100 , 102 , 104 , 107 , 109 , 112 , 114 ], and prior opioid use [ 5 , 53 , 57 , 58 , 61 , 63 , 64 , 67 , 68 , 73 , 74 , 78 , 82 , 83 , 85 – 89 , 95 , 97 – 100 , 102 – 104 , 107 – 109 , 111 , 113 , 114 ]. Amongst studies that included patients at risk for chronic opioid use, nearly 60% [ 51 , 53 , 63 , 64 , 72 , 74 , 78 , 82 , 83 , 85 , 89 , 94 , 95 , 97 – 100 , 102 – 104 , 106 , 10...…”

Section: Resultsmentioning

confidence: 99%

“…Among pharmacological strategies, we identified 18 studies [ 62 – 76 , 94 , 98 , 99 , 106 ], which mainly focused on the effect of anesthetic agents administered through regional anesthesia ( n = 8) [ 62 , 65 , 70 , 73 , 74 , 94 , 98 , 99 ] and the impact of medication on the central nervous system [ 63 , 66 , 67 , 69 ] ( n = 4) and opioid use. The educational strategies comprised seven studies on strategies aimed at providing patient information on the adequate use of opioids ( n = 6) [ 5 , 50 , 51 , 53 , 100 , 107 ] or aimed as a reminder to professionals on opioid prescribing guidelines ( n = 1) [ 52 ]. The multimodal strategies included eight studies testing strategies on multiple analgesic regimens or a combination of pharmacological and non-pharmacological strategies [ 56 – 58 , 68 , 84 , 101 , 108 , 110 ] and a transitional pain service [ 133 ].…”

Section: Resultsmentioning

confidence: 99%

“…The most commonly measured outcome was the quantity of opioids in morphine equivalent doses (MEDs) ( n = 44) [ 53 , 55 – 59 , 61 , 63 , 68 , 70 , 72 , 74 – 77 , 79 – 87 , 89 – 93 , 96 – 108 , 110 , 111 ], generally measured at 6 weeks or 1, 3 and 6 months. The proportion of patients using opioids was the second most frequently used outcome measure in the selected studies ( n = 25) [ 5 , 53 , 57 , 58 , 62 – 65 , 67 , 69 , 72 , 73 , 78 , 81 , 86 , 94 , 96 , 100 , 101 , 105 , 107 , 109 , 112 , 114 , 134 ] and this evaluation was often conducted at 3 ( n = 13) [ 5 , 53 , 57 , 62 , 63 , 65 , 72 , 81 , 94 , 100 , 105 , 112 , 114 ] and 6 months ( n = 6) [ 64 , 67 , 78 , 101 , 114 ]. The least frequently measured outcome was the proportion of patients who received an opioid prescription refill ( n = 18) [ 57 , 68 ,…”

Section: Resultsmentioning

confidence: 99%

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Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Côté

Bérubé

Moore

et al. 2022

BMC Musculoskelet Disord

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Background Long-term opioid use, which may have significant individual and societal impacts, has been documented in up to 20% of patients after trauma or orthopaedic surgery. The objectives of this scoping review were to systematically map the research on strategies aiming to prevent chronic opioid use in these populations and to identify knowledge gaps in this area. Methods This scoping review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We searched seven databases and websites of relevant organizations. Selected studies and guidelines were published between January 2008 and September 2021. Preventive strategies were categorized as: system-based, pharmacological, educational, multimodal, and others. We summarized findings using measures of central tendency and frequency along with p-values. We also reported the level of evidence and the strength of recommendations presented in clinical guidelines. Results A total of 391 studies met the inclusion criteria after initial screening from which 66 studies and 20 guidelines were selected. Studies mainly focused on orthopaedic surgery (62,1%), trauma (30.3%) and spine surgery (7.6%). Among system-based strategies, hospital-based individualized opioid tapering protocols, and regulation initiatives limiting the prescription of opioids were associated with statistically significant decreases in morphine equivalent doses (MEDs) at 1 to 3 months following trauma and orthopaedic surgery. Among pharmacological strategies, only the use of non-steroidal anti-inflammatory drugs and beta blockers led to a significant reduction in MEDs up to 12 months after orthopaedic surgery. Most studies on educational strategies, multimodal strategies and psychological strategies were associated with significant reductions in MEDs beyond 1 month. The majority of recommendations from clinical practice guidelines were of low level of evidence. Conclusions This scoping review advances knowledge on existing strategies to prevent long-term opioid use in trauma and orthopaedic surgery patients. We observed that system-based, educational, multimodal and psychological strategies are the most promising. Future research should focus on determining which strategies should be implemented particularly in trauma patients at high risk for long-term use, testing those that can promote a judicious prescription of opioids while preventing an illicit use, and evaluating their effects on relevant patient-reported and social outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Côté

Bérubé

Moore

et al. 2022

BMC Musculoskelet Disord

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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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Editorial Commentary: Opioid Sparing Through Patient Education Programs Is the Future for Sports Medicine and Arthroscopic Surgery to Optimize Outcome

Rossi¹

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The effect of preoperative education on opioid consumption in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial—2-year follow-up

Cited by 19 publications

References 17 publications

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Effect of a Postoperative Multimodal Opioid-Sparing Protocol vs Standard Opioid Prescribing on Postoperative Opioid Consumption After Knee or Shoulder Arthroscopy

Editorial Commentary: Opioid Sparing Through Patient Education Programs Is the Future for Sports Medicine and Arthroscopic Surgery to Optimize Outcome

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