Multimodal nonopioid pain protocol yielded effective pain control after ACL reconstruction
For patients undergoing ACL reconstruction, a multimodal nonopioid pain protocol effectively lowered VAS pain scores with no differences in complications or satisfaction compared with traditional opioid analgesics.
In their level-1, randomized controlled trial, Vasilios Moutzouros, MD, and investigators at Henry Ford Health System in Detroit randomized 34 patients undergoing primary ACL reconstruction (ACLR) to receive a multimodal nonopioid analgesic protocol, which consisted of acetaminophen, ketorolac, diazepam, gabapentin and meloxicam. Additionally, researchers randomized a matched cohort of 28 patients – also undergoing ACLR – to receive a traditional opioid pain regimen, which consisted of hydrocodone-acetaminophen. Outcome measures included postoperative VAS pain scores for 10 days, patient-reported outcomes (PROs), complications and satisfaction.
Overall, patients who received the multimodal nonopioid pain protocol had “significantly lower” VAS pain scores compared with patients who were assigned to the traditional opioid pain regimen both before (mean difference of 1.56) and after adjusting for confounders (mean difference of 1.71). However, “this difference was not observed over time between groups,” the researchers wrote in the study. No differences were found in overall pain control, PROs, complications or satisfaction, they added.
“Surgeons find themselves in the precarious position of wanting to minimize opioid use and optimize postoperative pain control and patient satisfaction,” the researchers wrote in the study. “Given the opioid epidemic, these results suggest that a multimodal nonopioid pain protocol may be a suitable alternative to opioid analgesia for pain management after ACLR.”
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