Can We Eliminate Opioids After Common Orthopedic Sports Procedures? A Novel Multimodal Pain Protocol

Abstract

The opioid epidemic has increased concerns about the safety of opioids and the appropriate management of pain with opioid medications. The purpose of this study was to to determine if postsurgical pain following common orthopedic sports procedures 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 common orthopedic sports procedures by a single sports surgeon from May 2018 to December 2018. The non-opioid pain protocol consisted of preoperative analgesics, intraoperative local infiltration analgesia, and a postoperative pain regimen. Patient pain levels were reported at 1 week postoperatively using the visual analogue scale and rescue opioids (oxycodone 5 mg) used were recorded and converted to morphine equivalents. A total of 141 patients were included. The average age of patients included was 37.8 ± 18.9 years, the average body mass index was 29.3 ± 7.1 kg/m2, and 66.0% of the patients were male. Forty-nine patients underwent anterior cruciate ligament reconstruction, 49 patients underwent arthroscopic meniscectomy, 27 patients underwent rotator cuff repair and 16 patients underwent arthroscopic labral repair. One week following surgery patients reported a mean visual analogue scale level of 3.1 ± 2.3 and required on average 2.6 ± 3.6 breakthrough oxycodone pills (5 mg), correlating to 8.6 ± 12.0 morphine equivalents. Forty-five percent of patients did not require any breakthrough narcotics 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). Patients undergoing a meniscus procedure were more likely to not require opioids, whereas patients undergoing rotator cuff repair or a labral repair were found to require more opioids postoperatively; P = .002. The most common side effect of the pain protocol was feeling drowsy (23.5%). All patients were satisfied with their pain management postoperatively. Our study found that a novel multimodal non-opioid pain protocol was 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 complications while using the protocol. Requirement of opioids postoperatively was found to be associated with pain level, procedure type and psychiatric diagnosis. These results suggest a non-opioid alternative to pain management following common orthopedic sports procedures.