Fewer opioid tablets as effective as higher quantities for postoperative pain
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COLORADO SPRINGS, Colo. — Prescribing fewer opioid tablets can be as effective in controlling postoperative pain after ACL reconstruction as higher quantities, according to data presented here.
“Patients would benefit from a lower prescription. That way there is less leftover opiod medications that they could use other ways,” Emma E. Johnson, BA, of Rothman Orthopaedic Institute, told Healio at the American Orthopaedic Society for Sports Medicine Annual Meeting.
In the randomized, prospective trial, Johnson and colleagues studied the effects of different quantities of prescribed opioid tablets on opioid utilization by 135 patients after primary ACL reconstruction for ACL tears. Overall, 41 patients received 15 tablets, 40 patients received 25 tablets and 49 patients received 35 tablets. All tablets were 5 mg of oxycodone.
Patients were instructed to take acetaminophen and NSAIDs as needed, and use of the opioid tablets was for breakthrough pain.
Patients completed pain and medication logs twice daily for the first 14 days after surgery, an opioid medication satisfaction survey at 2 weeks and IKDC questionnaires before surgery and up to 6 months postoperatively.
Researchers found no significant preoperative differences in subjective pain and function and no significant differences in mean total morphine milligram equivalents consumed among patients in the three groups (72.3 in the 15-tablet group, 61.9 in the 25-tablet group, 78.1 in the 35-tablet group; P > 0.05). There was a significant difference between patients who received 15 tablets and patients who received 25 and 35 tablets when asked if they thought they had been prescribed too few/too many narcotics, with a greater percentage of the 15-tablet group reporting that they believed they received too few opioid tablets at 20.6%.
Perspective
Back to TopThis prospective, randomized trial further emphasizes the importance and effectiveness of decreased postoperative opioid prescribing following ACL reconstruction. Previous studies have demonstrated the impact of fewer postoperative tablets on overall decreased consumption. However, this study also considers the patient’s perspective, which is growing in importance as models are shifting to patient-reported outcomes for reimbursement. Of note in this abstract, those patients that received the fewest number of tablets perceived that they were prescribed too few tablets, while consuming the same number of tablets and reporting similar satisfaction on the amount of postoperative pain relief as the other two groups which received more tablets. Patients’ perspectives are important but can also be mitigated through an extensive preoperative discussion regarding postoperative pain expectations. Utilizing a robust multimodal pain model has also been proven to both decrease postoperative pain and postoperative narcotic consumption. This abstract raises some interesting points and considerations. It would be interesting to see this study expanded in both the number of patients included and other surgeries.
Collapse
Johnson EE, et al. Paper 4. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 13-17, 2022; Colorado Springs, Colo.
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