Patient counseling, education may reduce opioid consumption after ACL reconstruction
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Key takeaways:
- Patient education and counseling may reduce opioid consumption after ACL surgery.
- Patients instructed to take opioids only as a “last resort” consumed less opioids vs. patients instructed to take “as needed.”
SAN FRANCISCO — According to presented results, a perioperative pain management education and counseling strategy may reduce opioid consumption in patients undergoing ACL reconstruction with no negative effects on pain control or outcomes.
“It has previously been shown that perioperative education can decrease opioid consumption after surgery; however, no [randomized controlled trials] have been performed to confirm this in either knee or arthroscopic surgery,” Jonathan D. Packer, MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Packer and colleagues from the University of Maryland performed a single-center, prospective, randomized controlled trial of 121 patients who underwent ACL reconstruction surgery.
According to abstract, patients were randomized to one of two perioperative pain management education and counseling strategies. One group of patients was prescribed 10 tablets of 5 mg oxycodone and instructed to take only as a “last resort” if the pain was unbearable. Another group of patients was prescribed 10 tablets of 5 mg oxycodone and instructed to take as needed for severe pain to “stay ahead of the pain.”
Outcome measures included total opioid consumption in milligram morphine equivalents (MMEs), numeric pain scale scores and patient-reported outcome scores for anxiety, depression and social satisfaction.
Opioids consumed
Overall, patients instructed to take opioids as a last resort consumed significantly fewer oxycodone tablets and less MMEs at postoperative day 1, 2, 3, 4, 7 and 14 compared with patients instructed to take opioids as needed.
In addition, the percentage of patients who consumed no opioid tablets by postoperative day 14 was higher in patients instructed to take opioids as a last resort (39.2%, n = 20) vs. patients instructed to take opioids as needed (11.5%, n = 6). Researchers noted neither group of patients was prescribed additional refills after 2 weeks.
Patient-reported outcomes
Packer and colleagues found patients instructed to take opioids as a last resort had better anxiety and social satisfaction scores at 2 weeks and better depression scores at 3 months compared with patients instructed to take opioids as needed.
“Patient education and counseling could be an effective method for minimizing opioid use without jeopardizing pain control or patient-reported outcomes,” Packer concluded.
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Packer JD, et al. Paper 005. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Feb. 12-16, 2024; San Francisco.
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