Abstract
PurposeCanada has the second-highest opioid use in the world. Despite knee and shoulder arthroscopy being among the most commonly performed orthopaedic procedures, there exists little guidelines for pain management.MethodsA survey was developed and distributed to members of the Arthroscopy Association of Canada. The objectives were: to understand opioid prescribing patterns after knee and shoulder arthroscopy, to determine if surgeons believe opioid over-prescription is an issue and to identify other pain management strategies surgeons are regularly using.ResultsA total of 38 responses were included (38.3%). Eighty-two percent of surgeons felt opioid over-prescription was an issue in arthroscopic surgery. The average post-operative knee or shoulder arthroscopy prescription included a total of 156 +/- 84.4 (0-400) mg of oral morphine equivalents (OMEs). Less than one-third of respondents (29%) had received formal peri-operative pain management training. Fifty-five percent of respondents felt that non-opioid medications do not provide adequate pain relief after arthroscopic surgery. Nearly all respondents (95%) stated they would change their prescription practice if high-quality evidence were to suggest that they should do so.ConclusionsThe majority of respondents identified opioid over-prescription as a problem after arthroscopic surgery. Surgeons are prescribing five times the amount of OMEs to patients that previous literature suggests the median patient uses after arthroscopic knee surgery. Surgeons generally state they would reduce or eliminate opioid prescriptions to arthroscopy patients if high-level evidence were to emerge suggesting that adequate pain control could be achieved without the use of narcotics.
Highlights
Canada has the second highest per-capita opioid use in the world, with a threefold increase in the rate of prescription opioid use over the past ten years [1,2]
Eighty-two percent of surgeons felt opioid over-prescription was an issue in arthroscopic surgery
The average post-operative knee or shoulder arthroscopy prescription included a total of 156 +/- 84.4 (0-400) mg of oral morphine equivalents (OMEs)
Summary
Canada has the second highest per-capita opioid use in the world, with a threefold increase in the rate of prescription opioid use over the past ten years [1,2]. Orthopaedic surgeons prescribe more opioid medications, including long-acting narcotics, than any other surgical specialty [6,7]. A recent database study across various surgical specialties found that 94% of patients undergoing elective surgery received opioid prescriptions at discharge, and that all orthopaedic surgery patients were well in excess of the recommended opioid prescription guidelines and had relatively high refill rates [8]. The vast majority (67-92%) of patients receiving prescription opioids after surgery report having unused narcotics, and only a quarter of these patients store their excess medications in locked containers [9]. In other areas of the world, patients take far fewer opioids compared with American and Canadian patients, but report similar pain and satisfaction with pain management [10]
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