Researchers from Henry Ford Hospital have found that patients can manage postoperative pain without opioids, or with only a minimal dose, following knee and shoulder sports medicine procedures.
The prospective study was published online ahead of print by Arthroscopy: The Journal of Arthroscopic & Related Surgery.
The researchers wanted to determine if postoperative pain following common sports medicine procedures could be managed effectively with a non-opioid, multimodal analgesic protocol that relied more heavily on non-steroidal and anti-inflammatory medicine. The study included 141 patients who had undergone anterior cruciate ligament reconstruction, surgery for a torn meniscus, or shoulder and rotator cuff repairs between May and December 2018.
A week after surgery, study participants reported mean VAS pain scores of 3.2 ± 2.3. More than half (55%) used some opioids for breakthrough pain (an average of 8.6 ± 12.0 morphine equivalents), but 45% did not need opioids to effectively controlled low levels of pain. Patients who required opioids were more likely to have a history of anxiety or depression (44.2% vs 23.8%; P = .012) and had higher pain scores than those who did not need opioids (3.94 ± 2.5 vs 2.41 ± 1.75; P = .016). All patients reported being satisfied with how their postoperative pain was managed.
“This kind of research has the potential to decrease opioid use in the general population as we find that many patients who abuse opioids started using them after a surgery and got hooked on them,” said Kelechi Okoroha, MD, a Henry Ford sports medicine physician and a study co-author. “It starts with the more common surgeries. By eliminating surgical opioid use, we are contributing to the reduction in opioids, which helps decrease dependence.”
Toufic R. Jildeh, MD, a study co-author and administrative chief resident in orthopaedics at Henry Ford, says sports medicine physicians can “play a direct role in improving pain management and decreasing opioid prescribing. There are currently no protocols that completely eliminate opioid use. This study strongly suggests that eliminating opioids postoperatively is actually possible,” he said.
Prior Henry Ford studies that focused on perioperative pain control and minimizing postoperative pain and opioid consumption after sports surgery led researchers to better understand risk factors that contribute to postoperative pain.
“It’s a practice changing study,” said Vasilios (Bill) Moutzouros, MD, chief of Sports Medicine, a division of the Department of Orthopaedic Surgery and the study’s lead author. “This type of research allows physicians to look at how we manage pain differently in the postsurgical environment. It allows us to change our practices and become safer.
“What we’re trying to do is support each individual patient and reassure them that we are going to prescribe little if any opioids for their pain control to mitigate or eliminate a potential for addiction.”
Moutzouros V, Jildeh TR, Khalil LS, et al. A multimodal protocol to diminish pain following common orthopedic sports procedures: can we eliminate postoperative opioids? Arthroscopy. 28 April 2020;S0749-8063(20)30334-0. doi: 10.1016/j.arthro.2020.04.018. Published online ahead of print.