Orthopedic surgical patients can recover without the use of opioid painkillers

Orthopedic surgical patients can recover without the use of opioid painkillers

Patients can recover from orthopedic surgery without the use of opioid-based painkillers, according to a study from McMaster University and Hamilton Health Sciences (HHS) published in the Journal of the American Medical Association (JAMA).

Study results showed that by prescribing a combination of three non-opioid painkillers to patients, researchers were able to reduce the amount of opioids they consumed by about 10-fold over a six-week period after surgery, with no change in their pain levels.

Co-principal investigator Olufemi Ayeni and his team collected their results by enrolling 193 patients from three hospitals in Hamilton between March 2021 and March 2022, including HHS's McMaster University Medical Center and Hamilton General Hospital, and St. Joseph's Healthcare Hamilton.

Patients were randomly assigned to either a control group of 98 who received standard opioid-based pain medications or an opioid-free group (93) who received combination therapy of naproxen, acetaminophen, and pantoprazole and a patient education infographic. The opioid-free group had access to opioid medications for pain when needed. Each patient who underwent outpatient arthroscopic knee or shoulder surgery was monitored for six weeks after surgery.

After the six weeks, participants in the control group had taken an average of 72.6 mg of opioids, compared to 8.4 mg in the opioid-sparing group. Six patients in the control group and two patients in the opioid-sparing group asked about opioid medications after discharge. The difference in pain scores, patient satisfaction with care, and number of adverse events was not significantly different.

This study clearly shows that many of these surgical patients can be safely treated without opioid medications in a select population.”

Olufemi Ayeni, professor of surgery at McMaster and orthopedic surgeon at HHS

“In addition, by reducing the number of opioids prescribed, we can collectively reduce the creation of a reservoir of unused drugs that can cause harm to many people in society,” he said.

“It is estimated that there are at least 100,000 of these surgeries each year in Canada, meaning that changing prescribing practices to reduce opioid use can reduce patient exposure and therefore the potential for opioid dependence.”

In comparison, Ayeni said more than one million orthopedic surgeries were performed annually in the United States from 2006 to 2016.

Opioids remain the postoperative painkiller of choice for orthopedic specialists on both sides of the border, but the ongoing opioid epidemic in North America is forcing clinicians to rethink, Ayeni said, adding that orthopedic specialists sometimes prescribe more opioids than recommended in medical guidelines.

Ayeni said that by switching to non-opioid pain medications after surgery, surgeons can do their part to combat the ongoing opioid epidemic and reduce the risk of addiction in patients recovering from orthopedic surgery.

Funding for the study was provided by Physician Services Incorporated and the Hamilton Health Sciences New Investigator Fund.

Source:

McMaster University

Reference:

The NO PAin Investigators., (2022) Effect of a Postoperative Multimodal Opioid-sparing Protocol Compared to Standard Opioid Prescription on Postoperative Opioid Consumption After Knee or Shoulder Arthroscopy A Randomized Clinical Trial. JAMA. doi.org/10.1001/jama.2022.16844.

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