Postoperative Opioid Reduction Using a Multimodal Pain Protocol for Outpatient Orthopaedic Sports Medicine Surgery

Background: Orthopaedic surgery regularly employs opioids for postoperative pain management. Multimodal pain protocols have been shown to reduce opioid prescriptions in orthopaedic surgery. Purpose: To analyze the impact of a division-level multimodal pain protocol for orthopaedic sports medicine su...

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Veröffentlicht in:Orthopaedic journal of sports medicine 2024-11, Vol.12 (11), p.23259671241255353
Hauptverfasser: Bernstein, Ethan M., Van Buren, J. Preston, Wolf, Kieran S.M., Cantor, Addison G., Wei Wu, Wei, Bailey, James R., Smith, Jennifer L.
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Sprache:eng
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Zusammenfassung:Background: Orthopaedic surgery regularly employs opioids for postoperative pain management. Multimodal pain protocols have been shown to reduce opioid prescriptions in orthopaedic surgery. Purpose: To analyze the impact of a division-level multimodal pain protocol for orthopaedic sports medicine surgery on opioid prescription reduction and pain level postoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: All orthopaedic sports medicine procedures at a military treatment facility were categorized into 1 of 3 pain tiers. A pain protocol emphasizing multimodal pain control was implemented for each tier. A retrospective cohort study compared pre- and postprotocol pain groups for each respective tier (n = 40 in each) for visual analog scale (VAS) for pain scores 2 weeks postoperatively, postoperative opioid prescription, and time to discontinuation of postoperative opioids. Results: The mean number of opioid pills prescribed for all tiers decreased by 43.6% (preprotocol 35.7 ± 3.1; postprotocol 20.1 ± 1.5; P < .0001) after pain protocol implementation. Of the total opioids prescribed in the postprotocol cohort, a mean of 64.1% were consumed. There was no significant difference in overall visual analog scale for pain scores at 2 weeks postoperatively (preprotocol 2.72 ± 0.41; postprotocol 2.99 ± 0.43; P = .40). At 2 weeks postoperatively, only 1 patient continued opioids in the postprotocol group compared with 20 patients with continued opioid use in the preprotocol group (P < .001). Conclusion: A division-level multimodal pain protocol applied to orthopaedic sports medicine procedures led to decreased opioid prescription postoperatively with no significant difference in 2-week postoperative pain scores compared with more opioid reliant and variable protocols in a cohort of military service members. Despite the reduced prescription, patients consumed a mean of 64.1% of pills, indicating continued overprescription.
ISSN:2325-9671
2325-9671
DOI:10.1177/23259671241255353