Can We Eliminate Opioids After ACL Reconstruction? A Prospective Randomized Controlled Trial

Abstract

The opioid epidemic has increased concerns about the safety of opioids and the appropriate management of pain with opioid medications creating the need for controlling postoperative pain without narcotics. The purpose of this study was to determine if postsurgical pain following anterior cruciate ligament reconstruction could be managed effectively with a nonnarcotic multimodal analgesic protocol. We performed a prospective study evaluating a novel multimodal non-opioid pain protocol in all patients undergoing anterior cruciate ligament reconstruction from January 2019 to June 2019. Patients were randomized to either a traditional pain protocol consisting of hydrocodone 5 mg/acetaminophen 325 mg or a novel non-opioid pain protocol. The non-opioid pain protocol consisted of preoperative analgesics, intraoperative local infiltration analgesia, and a postoperative pain regimen. Patient VAS pain levels and PROMIS pain interference levels (PI) were reported using a text message service. A total of 26 patients were included. The average age of patients included was 26.9 ± 11.7 years, the average body mass index was 27.5 ± 3.8kg/m2, and 44.0% of the patients were male. Patients on the nonnarcotic protocol had statistically significant improvements (p<0.05) in VAS pain scores at all time points on post-operative days 1-10. There was no difference in PROMIS PI levels among patients administered narcotics (59.1 ± 7.2 vs. 65.6 ± 6.6, p=0.051) and the non-narcotic protocol (58.7 ± 5.8 vs. 57.4 ± 10.5, p= 0.348). The most common side effect of the narcotic pain protocol was constipation (33.0%) and drowsiness (23.5%) for the non-narcotic pain protocol. All patients (100%) were satisfied with their pain management postoperatively. Patients undergoing an anterior cruciate ligament reconstruction with non-narcotic protocol showed improved pain scores, equivalent PROMIS PI scores, and an alternative side-effect profile as compared to traditional narcotic analgesia.