Opioid-free pain management pathway may yield similar pain outcomes as opioid pathway
Key takeaways:
- An opioid-free protocol yielded noninferior pain scores vs. an opioid-containing protocol at 24 hours after orthopedic surgery.
- The opioid-free group also had improved comfort and satisfaction scores.
According to published results, a novel opioid-free pathway may provide noninferior pain management compared with an opioid-containing pathway during the perioperative period in patients undergoing orthopedic surgery.
“On average, patients treated with an opioid-free pain protocol experienced pain levels at 24 hours that were statistically noninferior to those for patients treated with an opioid-containing protocol,” Robby Turk, MD, MBA, and colleagues at OrthoCarolina wrote in the study. “Significantly more patients in the opioid-free group self-reported satisfaction with pain control and comfort levels at multiple time points during the postoperative recovery period.”
Turk and colleagues performed a randomized controlled trial of 315 patients (mean age, 63.6 years) who underwent common, elective orthopedic surgeries, such as spine surgery, first carpometacarpal arthroplasty, hallux valgus or hallux rigidus correction, total or reverse shoulder arthroplasty and total hip arthroplasty. Turk and colleagues randomly assigned 157 patients to receive an opioid-free pain management protocol and 158 patients to receive an opioid-containing pain management protocol.
The primary outcome for noninferiority analysis was numeric rating scale (NRS) pain scores at 24 hours at surgery. Turk and colleagues also assessed NRS pain scores at 6 hours, 12 hours, 2 weeks, 6 weeks and 1 year after surgery. Other outcomes included total opioids consumed in the opioid-containing group (in morphine milligram equivalents), readmissions and complications.
Turk and colleagues found pain scores in the opioid-free group (NRS = 2) were statistically noninferior to pain scores in the opioid-containing group (NRS = 4) at 24 hours. In addition, they found decreased pain scores in opioid-free group at 12 hours and at 2 weeks compared with the opioid-containing group. They noted pain scores at 6 hours, 6 weeks and 1 year were similar between the groups.
Patients who received the opioid-free protocol had significantly greater comfort scores at 24 hours and satisfaction scores at 6 weeks compared with the opioid-containing group. Turk and colleagues found no significant differences in rates of unplanned readmissions or complications between the groups.
“We recommend that this completely opioid-free perioperative pain protocol be strongly considered for interested patients undergoing elective orthopedic surgical procedures,” Turk and colleagues concluded.
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