Arthroscopy Association of Canada Position Statement on Opioid Prescription After Arthroscopic Surgery

Nicholas Nucci; Ryan Degen; Seper Ekhtiari; Aaron Gazendam; Olufemi R Ayeni; Nolan Horner; Ivan Wong; Jarret Woodmass; John Grant; Brendan Sheehan; Michael Pickell; Michaela Kopka; Moin Khan; Ryan Martin; Allison Tucker; Mark Sommerfeldt; Eva Gusnowski; Alexis Rousseau-Saine; Marie-Eve Lebel; Jillian Karpyshyn; Bogdan Matache; Michael Carroll; Rachael Da Cunha; Adam Kwapisz; R Kyle Martin

doi:10.1177/23259671231214700

Arthroscopy Association of Canada Position Statement on Opioid Prescription After Arthroscopic Surgery

Orthop J Sports Med. 2023 Dec 22;11(12):23259671231214700. doi: 10.1177/23259671231214700. eCollection 2023 Dec.

Authors

Nicholas Nucci¹, Ryan Degen², Seper Ekhtiari³, Aaron Gazendam³, Olufemi R Ayeni³, Nolan Horner⁴, Ivan Wong⁵, Jarret Woodmass⁶, John Grant⁷, Brendan Sheehan⁸, Michael Pickell¹, Michaela Kopka⁹, Moin Khan³, Ryan Martin¹⁰, Allison Tucker¹¹, Mark Sommerfeldt¹², Eva Gusnowski⁸, Alexis Rousseau-Saine¹³, Marie-Eve Lebel², Jillian Karpyshyn¹², Bogdan Matache¹⁴, Michael Carroll¹⁵, Rachael Da Cunha¹⁶, Adam Kwapisz⁶, R Kyle Martin¹⁷

Affiliations

¹ University of Ottawa, Ottawa, Ontario, Canada.
² Western University, London, Ontario, Canada.
³ McMaster University, Hamilton, Ontario, Canada.
⁴ Genesis Orthopaedics & Sports Medicine, Chicago, Illinois, USA.
⁵ Dalhousie University, Halifax, Nova Scotia, Canada.
⁶ University of Manitoba, Winnipeg, Manitoba, Canada.
⁷ University of Michigan, Ann Arbor, Michigan, USA.
⁸ Saint John Orthopaedics, Saint John, New Brunswick, Canada.
⁹ Banff Sport Medicine, Canmore, Alberta, Canada.
¹⁰ University of Calgary, Calgary Alberta, Canada.
¹¹ Nova Scotia Health Authority, Halifax Nova Scotia, Canada.
¹² University of Alberta, Edmonton Alberta, Canada.
¹³ University of Montreal, Montreal, Quebec, Canada.
¹⁴ Laval University, Quebec City Quebec, Canada.
¹⁵ Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Canada.
¹⁶ Queen's University, Kingston Ontario, Canada.
¹⁷ University of Minnesota, Minneapolis, Minnesota, USA.

Abstract

Background: Despite the ongoing opioid epidemic, most patients are still prescribed a significant number of opioid medications for pain management after arthroscopic surgery. There is a need for consensus among orthopaedic surgeons and solutions to aid providers in analgesic strategies that reduce the use of opioid pain medications.

Purpose: This position statement was developed with a comprehensive systematic review and meta-analysis of exclusively randomized controlled trials (RCTs) to synthesize the best available evidence for managing acute postoperative pain after arthroscopic surgery.

Study design: Position statement.

Methods: The Embase, MEDLINE, PubMed, Scopus, and Web of Science databases were searched from inception until August 10, 2022. Keywords included arthroscopy, opioids, analgesia, and pain, and associated variations. We included exclusively RCTs on adult patients to gather the best available evidence for managing acute postoperative pain after arthroscopic surgery. Patient characteristics, pain, and opioid data were extracted, data were analyzed, and trial bias was evaluated.

Results: A total of 21 RCTs were identified related to the prescription of opioid-sparing pain medication after arthroscopic surgery. The following recommendations regarding noninvasive, postoperative pain management strategies were made: (1) multimodal oral nonopioid analgesic regimens-including at least 1 of acetaminophen-a nonsteroidal anti-inflammatory drug-can significantly reduce opioid consumption with no change in pain scores; (2) cryotherapy is likely to help with pain management, although the evidence on the optimal method of application (continuous-flow vs ice pack application) is unclear; (3) and (4) limited RCT evidence supports the efficacy of transcutaneous electrical nerve stimulation and relaxation exercises in reducing opioid consumption after arthroscopy; and (5) limited RCT evidence exists against the efficacy of transdermal lidocaine patches in reducing opioid consumption.

Conclusion: A range of nonopioid strategies exist that can reduce postarthroscopic procedural opioid consumption with equivalent vocal pain outcomes. Optimal strategies include multimodal analgesia with education and restricted/reduced opioid prescription.

Keywords: arthroscopy; opioids; postoperative; reduction.