The Utility of Oral Nonsteroidal Anti-inflammatory Drugs Compared With Standard Opioids Following Arthroscopic Meniscectomy: A Prospective Observational Study

Pham, Hien; Pickell, Michael; Yagnatovsky, Michelle; Kramarchuk, Mark; Alaia, Michael J.; Strauss, Eric J.; Jazrawi, Laith M.; Campbell, Kirk A.

doi:10.1016/j.arthro.2018.09.018

Cited by 24 publications

(23 citation statements)

References 29 publications

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“…[12][13][14][15][16][17][18][19] Gimbel et al 14 studied a variety of orthopaedic procedures and concluded that celecoxib may serve as a better option for postoperative pain control compared with hydrocodone/acetaminophen. A recent study by Pham et al 19 showed that use of oral NSAIDs (ibuprofen) and limited narcotics resulted in excellent pain relief and patient satisfaction after arthroscopic meniscectomy, which supports our current findings for limited narcotics after an arthroscopic procedure. Although our study used ibuprofen, other investigators have suggested a variety of viable nonopioid options such as acetaminophen, transdermal buprenorphine, and cannabinoids.…”

Section: Discussionmentioning

confidence: 99%

Opioid Use Is Reduced in Patients Treated with NSAIDs After Arthroscopic Bankart Repair: A Randomized Controlled Study

Thompson

Klein

Alaia

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To evaluate the efficacy of oral nonsteroidal anti-inflammatory drugs (NSAIDs) as the primary postoperative pain medication compared with standard oral opioids after arthroscopic shoulder capsulolabral (Bankart) repair for recurrent anterior shoulder instability. Methods This was a single-center, prospective, randomized controlled study. Patients aged 18 to 65 years indicated for arthroscopic shoulder capsulolabral repair for recurrent anterior shoulder instability were included. Postoperatively, patients were prescribed 1 of 2 analgesic regimens: (1) 30 ibuprofen (600 mg every 6 to 8 hours as needed) and 10 tablets of oxycodone/acetaminophen (5/325 mg every 6 hours as needed for breakthrough pain) or (2) 30 tablets oxycodone/acetaminophen (5/325 mg every 6 hours as needed). Subjects completed questionnaires at 24, 48, and 96 hours and 1 week after surgery, which included questions about analgesic medication usage, visual analog scale (VAS) pain score, incidence of adverse events, and patient satisfaction. Results Between December 2017 and May 2019, 80 patients (mean age 31.3 ± 10.4 years) were enrolled. Overall there were no significant differences in VAS pain score or patient satisfaction between the 2 groups. Patients in the opioid-only group had a significantly higher mean opioid consumption on postoperative days (PODs) 2 to 4 (5.5 versus 2.9, P = .05) and after 1 week (11.7 versus 7.9 tablets, P = .05) compared with patients in the NSAID group. Of patients in the NSAID group, 17.5% experienced adverse effects, compared with 35% in the opioid-only group. Conclusions Use of oral NSAIDs with limited breakthrough opioids results in significantly less opioid use after arthroscopic Bankart repair in the first postoperative week compared with opioids only. Both groups used limited amounts of opioids to control postoperative pain. There were no differences in pain levels at any time point postoperatively or satisfaction between patient groups. Level of Evidence II, nonblinded randomized control trial.

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Section: Discussionmentioning

confidence: 99%

Opioid Use Is Reduced in Patients Treated with NSAIDs After Arthroscopic Bankart Repair: A Randomized Controlled Study

Thompson

Klein

Alaia

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Efforts have been made to identify synergistic compounds to use for acute pain management in the perioperative time period, all of which report some degree of opioid-sparing effects. These studies have focused on the safety and efficacy of gabapentinoids [14][15][16], local administration of sodiumchannel blockers such as lidocaine and bupivacaine [17][18][19], opioid-free anesthesia [20][21][22], cryotherapy [23,24], dexamethasone [25,26], and non-steroidal anti-inflammatories (NSAIDs) and acetaminophen [27][28][29][30][31][32][33].…”

Section: Background and Rationalementioning

confidence: 99%

Study protocol: randomized controlled trial of opioid-free vs. traditional perioperative analgesia in elective orthopedic surgery

Shing

Leas

Michalek

et al. 2021

BMC Musculoskelet Disord

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Background The medical community is beginning to recognize the contribution of prescription opioids in the growing national opioid crisis. Many studies have compared the safety and efficacy of alternative analgesics to opioids, but none utilizing a completely opioid-free perioperative protocol in orthopedics. Methods We developed and tested an opioid-free perioperative analgesic pathway (from preoperative to postoperative period) among patients undergoing common elective orthopedic procedures. Patients will be randomized to receive either traditional opioid-including or completely opioid-free perioperative medications. This study is being conducted across multiple orthopedic subspecialties in patients undergoing the following common elective orthopedic procedures: single-level or two-level ACDF/ACDA, 1st CMC arthroplasty, Hallux Valgus/Rigidus corrections, diagnostic knee arthroscopies, total hip arthroplasty (THA), and total shoulder arthroplasty/reverse total shoulder arthroplasty (TSA/RTSA). The primary outcome measure is pain score at 24 h postoperatively. Secondary outcome measures include pain scores at additional time points, medication side effects, and several patient-reported variables such as patient satisfaction, quality of life, and functional status. Discussion We describe the methods for a feasibility randomized controlled trial comparing opioid-free perioperative analgesics to traditional opioid-including protocols. We present this study so that it may be replicated and incorporated into future studies at other institutions, as well as disseminated to additional orthopedic and/or non-orthopedic surgical procedures. The ultimate goal of presenting this protocol is to aid recent efforts in reducing the impact of prescription opioids on the national opioid crisis. Trial registration The protocol was approved by the local institutional review board and registered with clinicaltrials.gov (Identifier: NCT04176783) on November 25, 2019, retrospectively registered

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“…Recently, some groups have evaluated the role of NSAIDs alone for postoperative analgesia after arthroscopic meniscectomy. Pham et al 25 reported that, when given prescriptions for both an NSAID and an opioid after arthroscopic meniscectomy, more than half of patients reported taking the NSAID alone, and Daniels et al 26 reported 82% satisfactory postoperative analgesia when providing NSAIDs alone after arthroscopic meniscectomy. Our report helps build on these findings, showing that, in those situations in which either surgeon or patient preference dictates the prescription of a postoperative opioid, proper preoperative education can help to limit the number of opioid pills taken in the postoperative period.…”

Section: Prospectively Analyzedmentioning

confidence: 99%

Preoperative Patient Education May Decrease Postoperative Opioid Use After Meniscectomy

Andelman

Debellis

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To identify the current opioid prescribing and use practices after arthroscopic meniscectomy and to evaluate the role of preoperative patient education in decreasing postoperative opioid consumption. Methods: Patients undergoing arthroscopic meniscectomy were prospectively identified for inclusion. They were placed into 1 of 2 groups: Group 1 received no education regarding opioid use after surgery, whereas group 2 received a standardized overview on postoperative opioid use. Patients were assigned to the groups consecutively: Patients treated at the beginning of the study were assigned to group 1, and patients treated at the end of the study were assigned to group 2. Data from group 1 were used to identify "normal" opioid prescribing and use practices and to guide patients in group 2 regarding normal postoperative opioid use. Patients were surveyed weekly for 4 weeks after surgery to determine the number of opioids taken. Postoperative opioid consumption was analyzed and compared between the 2 groups. Results: A total of 62 patients completed the study (32 in group 1 and 30 in group 2). Patients in group 1 were prescribed an average of 42.0 opioid pills (95% confidence interval [CI], 34.0-51.0 pills) and used an average of 15.84 pills (95% CI, 9.26-22.4 pills) after surgery, whereas patients in group 2 used an average of 4.00 pills (95% CI, 2.12-5.88 pills) after surgery. Patients in group 2 used 11.84 fewer opioid pills (P ¼ .001), a 296% decrease in postoperative opioid consumption. The number of patients who continued to take opioid pills 4 weeks after surgery was 7 patients (21.9%) in group 1 and 1 patient (3.3%) in group 2. Conclusions: Preoperative patient education regarding opioids may decrease postoperative opioid consumption and the duration for which patients take opioid pills after arthroscopic meniscectomy. Level of Evidence: Level II, prospective comparative study.

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The Utility of Oral Nonsteroidal Anti-inflammatory Drugs Compared With Standard Opioids Following Arthroscopic Meniscectomy: A Prospective Observational Study

Cited by 24 publications

References 29 publications

Opioid Use Is Reduced in Patients Treated with NSAIDs After Arthroscopic Bankart Repair: A Randomized Controlled Study

Opioid Use Is Reduced in Patients Treated with NSAIDs After Arthroscopic Bankart Repair: A Randomized Controlled Study

Study protocol: randomized controlled trial of opioid-free vs. traditional perioperative analgesia in elective orthopedic surgery

Preoperative Patient Education May Decrease Postoperative Opioid Use After Meniscectomy

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