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Education program linked with decreased narcotic use after arthroscopic rotator cuff repair
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TORONTO — After patients scheduled to undergo arthroscopic rotator cuff repair viewed a 2-minute video and received a fact sheet preoperatively, they used less narcotics for pain and had lower pain scores postoperatively than patients who did not receive this education prior to surgery, according to a presenter at the American Orthopaedic Society for Sports Medicine Annual Meeting.
Fotios P. Tjoumakaris, MD , said in his presentation, “Preoperative education intervention significantly reduced narcotic consumption at 3 months following arthroscopic rotator cuff repair. There is also evidence that it results in early cessation of opioids and, certainly, patient-directed education can alleviate the current opioid epidemic.”
Patients enrolled in the prospective trial were at least 18 years and indicated for arthroscopic rotator cuff repair surgery. Their randomization resulted in 68 patients in the study group, who received the educational materials, and 66 patients in the control group. Tjoumakaris said the control group received the standard operative protocol with regard to opioid medication, but were given no education about opioid consumption.
Both groups of patients were medicated at the surgical center with 975 mg Tylenol (acetaminophen, McNeil) and 75 mg oral Lyrica (pregabalin, Pfizer). They were given a prescription for Percocet (percocet, Endo Pharmaceuticals). Tjoumakaris said refills were standardized at 30 pills of 5 mg Percocet or 5 mg oxycodone.
Patients were asked to track their opioid use in a pain diary. Postoperative follow-up was at 2 weeks, 6 weeks and 3 months, at which time the patients’ VAS pain scores were collected and the number of pills that remained in their prescriptions was determined.
“Overall, the study group consumed significantly fewer narcotics, specifically at 6 weeks and 3 months,” Tjoumakaris said. “Overall, the study group also reported lower VAS pain scores at the 2-week and 6-week follow-up. Our multivariate analysis showed randomization to the study group, VAS score at 3 months and preoperative narcotic use were indicative of postoperative consumption, which basically means if you were in the study group you used less narcotics.”
Among the study limitations were that investigators weakly explored the patients’ preoperative narcotic use and that drug consumption during the study was self-reported.
“We did not further query patients,” Tjoumakaris said. To counteract that limitation, he said all patients were blinded to the true purpose of the study, which was narcotics education designed to reduce narcotic consumption. – by Susan M. Rapp
Reference:
Tjoumakaris FP, et al. Paper #173. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 20-23, 2017; Toronto.
Disclosure: Tjoumakaris reports no relevant financial disclosures.