Zolpidem Reduces Postoperative Pain, Fatigue, and Narcotic Consumption Following Knee Arthroscopy: A Prospective Randomized Placebo-Controlled Double-Blinded Study

Abstract

Sixty-eight patients undergoing outpatient knee arthroscopy for treatment of meniscal tears or loose bodies were divided into three treatment groups (zolpidem [24 patients], control [24 patients], and placebo [20 patients]). All groups received postoperative hydrocodone and ibuprofen. Patients in the zolpidem group received a single dose of zolpidem tartrate for the fi rst seven postoperative nights. Patients in the placebo group received a gelatin capsule similar in appearance to zolpidem and patients in the control group received only hydrocodone and ibuprofen. Patients in the control group demonstrated signifi cantly worse mean daily postoperative pain and more daily postoperative fatigue on visual analog scales when compared with the zolpidem group (Pϭ.03 and Pϭ.04, respectively). Patients in the placebo group had worse daily postoperative pain and more daily postoperative fatigue when compared to the zolpidem group, although these differences did not reach statistical signifi cance (Pϭ.15, powerϭ0.6; and Pϭ.27, powerϭ0.48, respectively). Patients in the control group consumed signifi cantly higher quantities of hydrocodone/acetaminophen postoperatively (Pϭ.04) than patients in the zolpidem group. Finally, patients in the placebo group consumed higher quantities of hydrocodone/acetaminophen than the zolpidem group although the difference did not reach statistical signifi cance (Pϭ.4; powerϭ0.15). Power was calculated for each insignifi cant relationship based on observed effect and sample sizes and variances.This study demonstrates that sleep and fatigue may be an important factor in the effective pain management following knee arthroscopy. Future postoperative treatment regimens should address sleep and fatigue to maximize analgesic effects in these patients.

Integrating Modern Concepts of Insomnia and its Contemporary Treatment into Primary Care

“…Conversely, successful treatment of insomnia may improve certain comorbidities such as depression 48 and surgery-related pain. 49 Physicians also should be alert to the possibility of new-onset insomnia in chronically ill patients, as a fair proportion develop sleep problems. 44 Evaluating the Patient A problem-focused physical examination and detailed medical history of the patient, as well as a history of the sleep complaint, can help establish the proper diagnosis.…”

The Analgesic Properties of Zolpidem

“…2,3 There was also a significant reduction in narcotic usage in patients given zolpidem compared with the control group, but again not with the placebo group. 2,3 Zolpidem may have either an agonist or antagonist effect on algesia and its inflammatory mediators, such as histamine, prostaglandins, or cytokines. 4 Zolpidem has been shown to decrease total lipids, total cholesterol, and triglycerides in hyperlipidemia induced by administration of a non-ionic detergent (Triton WR-1339).…”

“…2,3 Both studies found that there was a significant improvement in pain and fatigue in patients given zolpidem compared with the control group, but not with the placebo group. 2,3 There was also a significant reduction in narcotic usage in patients given zolpidem compared with the control group, but again not with the placebo group. 2,3 Zolpidem may have either an agonist or antagonist effect on algesia and its inflammatory mediators, such as histamine, prostaglandins, or cytokines.…”

Reducing the Pain: A Systematic Review of Postdischarge Analgesia Following Elective Orthopedic Surgery

“…The analgesic efficacy of the imidazopyridine hypnotic agent zolpidem was compared with placebo and control following knee arthroscopy [53]. Pain intensity, rescue medication consumption, and fatigue were significantly reduced in the zolpidem group compared with control.…”