Opioid-free protocol offers pain control during thumb carpometacarpal joint arthroplasty
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Key takeaways:
- An opioid-free protocol provided pain relief for patients undergoing thumb carpometacarpal joint arthroplasty.
- Patients in the opioid-free group had less pain than patients in the opioid-containing group.
Results published in the Journal of Bone and Joint Surgery showed an opioid-free perioperative protocol effectively provided pain relief for patients undergoing thumb carpometacarpal joint arthroplasty.
Researchers at OrthoCarolina performed a single-center, randomized controlled trial of 26 patients who received an opioid-free protocol and 24 patients who received an opioid-containing protocol for pain management during primary thumb carpometacarpal (CMC) joint arthroplasty.
The opioid-free protocol consisted of a combination of cryotherapy, anti-inflammatory medication, acetaminophen and gabapentin, while the opioid-containing protocol consisted of cryotherapy and opioid-containing medication. Researchers also noted all patients received a preoperative, ultrasound-guided brachial plexus block with 30 mL of 0.5% ropivacaine.
Outcome measures included patient-reported pain scores on a numeric rating scale of 0 to 10, opioid-related side effects, patient satisfaction and the Veterans RAND 12-item health survey (VR-12).
At 24 hours postoperatively, median pain score was 2 in the opioid-free group and 4 in the opioid-containing group. At 2 weeks postoperatively, median pain score was also 2 in the opioid-free group and 4 in the opioid-containing group. At 6 weeks postoperatively, median pain score was 1.5 in the opioid-free group and 3 in the opioid-containing group.
Satisfaction and VR-12 scores were similar between the groups at all postoperative time points, and researchers noted no differences in opioid-related adverse events between the groups.
“Although further research is needed to confirm these findings, we believe that well-designed [opioid-free] pain management pathways can be utilized in thumb CMC joint arthroplasty to improve patient care and to minimize the negative effects of opioid use,” the researchers wrote in the study.
Perspective
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I would like to commend the authors for performing a well-designed, prospective, randomized study examining the effects of opioid-free medications to patients on opioids for postoperative pain control after undergoing trapeziectomy and ligament reconstruction and tendon interposition or abductor pollicis longus to flexor carpi radialis suture suspension. This is particularly important given that opioid abuse is the leading cause of accidental deaths within our nation. I was particularly keen to read the outcomes of this study as recovery from basilar thumb joint arthritis surgery can be painful, especially in the immediate postoperative setting.
Fifty patients were included, 26 within the opioid-free and 24 in the opioid-containing groups. The opioid-free pathway comprised multimodal preoperative and postoperative medications including meloxicam, gabapentin, Tylenol and toradol. The patients had similar demographics and mental well-being scores, an important consideration for how pain can be perceived by patients. Results demonstrated lower pain scores at 24 hours after surgery (primary outcome measure) in the opioid-free cohort and this continued up to 2 weeks postoperatively and was similar to the opioid-containing patients at 6 weeks after surgery, with equivalent side-effect profiles. The authors comment on the importance of patient education to improve patient-perceived pain after surgery. Limitations of potential selection bias, the patients being unblinded to their analgesia, the quality of regional anesthesia and the limited number of patients in each group were noted. Notwithstanding these, I would urge all hand surgeons to read this article to help the recovery of their patients.
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