Lower opioid quantity did not impact pain control, satisfaction after ACL reconstruction
Key takeaways:
- Patients who received 15, 25 and 35 opioid tablets had similar pain and satisfaction after ACL reconstruction.
- Most patients prescribed 15 tablets reported receiving the “right amount” or “too many” opioids.
Published results showed patients who received a prescription of 15 opioid tablets had similar pain control and patient satisfaction after ACL reconstruction compared with patients who received prescriptions for 25 or 35 tablets.
William L. Johns, MD, and colleagues from the Rothman Orthopaedic Institute at Thomas Jefferson University Hospital performed a prospective, randomized trial of 180 patients who underwent primary ACL reconstruction between March 2019 and November 2022.
According to the study, 60 patients were prescribed 15 5 mg oxycodone tablets for postoperative pain control; 58 patients were prescribed 25 tablets; and 62 patients were prescribed 35 tablets.
“The initial amount of opioids prescribed by the medical provider is among the greatest modifiable risk factor for opioid excess, a contributor to subsequent diversion, dependence and misuse of opioids,” Johns and colleagues wrote.
Overall, the researchers found no significant difference in VAS scores, IKDC scores, morphine milligram equivalents consumed or patient satisfaction of pain control between any of the treatment groups. They found 72% of opioids were consumed in the first 3 days postoperatively. They also noted 83% of patients who were prescribed 15 tablets reported receiving the “right amount” or “too many” opioids.
“This suggests that lower prescription quantities of opioid medication provide equivalent postoperative pain and may help to minimize the number of unused opioids at risk for possible diversion after ACL reconstruction,” Johns and colleagues concluded.
Perspective
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Much data have been published regarding narcotic reduction strategies in orthopedic trauma patients, and I commend the authors for investigating pain responsiveness after outpatient ACL reconstructive surgery. It has been shown that 6% to 13% of orthopedic surgery patients who receive prescription narcotic analgesics for postoperative pain may develop long-term opioid dependence. Adequate pain control is not only a patient satisfier; but I think the more appropriate measure is pain control that allows the patient to participate in postoperative rehabilitation. Early range of motion is imperative after ACL surgery, and inadequate pain control is a potential threat for arthrofibrosis. Therefore, I agree with the authors that limited narcotic analgesics are appropriate in the early postoperative recovery through 14 days. However, the study has potential to change practice patterns where I could foresee preoperative counseling with patients and families to offer limited narcotic prescribing of 15 tablets or an opioid-sparing multimodal approach, thereby acknowledging the risk of dependence in open conversation in advance of surgery.
References:
Brummett CM, et al. JAMA Surg. 2017;doi:10.1001/jamasurg.2017.0504.
Holman JE, et al. J Bone Joint Surg Am. 2013;doi:10.2106/JBJS.L.00619.
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