Patient expectations for opioid analgesia following orthopaedic surgery

Correspondence to George C Balazs, Investigation Performed at Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708, USA; gcbalazs@gmail.com Orthopaedic surgeons are the third highest opioid prescribing speciality in the USA. 1 Studies have consistently shown that most postoperative opioids go unused, 2–5 and that there is a direct relationship between the quantity of opioids prescribed and the likelihood of prolonged use/misuse of opioids following surgery. 6 Currently published guidelines place a strong emphasis on managing patient expectations for postoperative analgesia, but no study has reported actual patient expectations for opioid management following orthopaedic surgery. Following Institutional Review Board approval, a three-question anonymous survey was provided to all patients seen for any reason in our multi-subspeciality orthopaedic surgery clinic in May 2018. Upwards of 20% of the patients engage in ‘doctor shopping’ for additional opioid prescriptions after traumatic orthopaedic injuries. 7 8 In a study of 207 patients with trauma, Gangavalli et al reported that 19% felt their pain medication was under-prescribed, 12% admitted to taking more than the prescribed dosage and 9% admitted to obtaining opioids from other sources than their physician.