A Multimodal Protocol to Diminish Pain Following Common Orthopedic Sports Procedures: Can We Eliminate Postoperative Opioids?
Moutzouros V, Jildeh TR, Khalil LS, Schwartz K, Hasan L, Matar RN, and Okoroha KR. A Multimodal Protocol to Diminish Pain Following Common Orthopedic Sports Procedures: Can We Eliminate Postoperative Opioids? Arthroscopy 2020.
PURPOSE: To determine if postsurgical pain, measured by visual analogue scale (VAS), following common orthopedic sports procedures could be managed effectively with a nonopioid multimodal analgesic protocol.
METHODS: This prospective study evaluated a custom multimodal non-opioid pain protocol in patients undergoing common orthopedic sports procedures by a single fellowship trained Orthopaedic Sports surgeon from May 2018 to December 2018. Procedures included anterior cruciate ligament reconstruction, rotator cuff repair, arthroscopic partial meniscectomy, and labrum repair. The non-opioid pain protocol consisted of preoperative analgesics, intraoperative local infiltration analgesia, and a postoperative pain regimen. Patient pain was immediately reported after surgery and 1 week postoperatively using the VAS, while rescue opioids (oxycodone 5 mg) used were recorded using a prescription opioid journal. Statistical analysis of patient VAS scores, demographic correlations, and comparison between opioid rescue users vs. nonusers was performed.
RESULTS: A total of 141 patients were included. One week following surgery patients reported a mean VAS level of 3.2±2.3 and required on average 2.6±3.6 breakthrough oxycodone pills (8.6±12.0 morphine equivalents). Forty-five percent of patients did not require any breakthrough prescription opioids and reported satisfaction with pain management. Patients who required opioids were more likely to have a history of anxiety/depression (44.2% vs. 23.8%,P=.012) and reported higher pain scores as compared to non-users (3.94±2.5 vs. 2.41±1.75,P=.016). The most common side effect of the pain protocol was feeling drowsy (23.5%). All patients were satisfied with their pain management postoperatively.
CONCLUSIONS: A multimodal, non-opioid pain protocol was found to be effective in managing postoperative pain following common orthopedic sports procedures. Patients were found to have low levels of pain, require minimal rescue opioids and had no severe side effects related to the protocol. These results suggest a non-opioid alternative to pain management following common orthopedic sports procedures.
ePub ahead of print