Opiates Prescribing for Knee Arthroscopies and ACL Reconstruction
| Status: | Recruiting |
|---|---|
| Conditions: | Hospital, Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry, Other |
| Healthy: | No |
| Age Range: | 18 - 89 |
| Updated: | 3/20/2019 |
| Start Date: | March 26, 2018 |
| End Date: | December 31, 2020 |
| Contact: | Surabhi Bhatt, BS |
| Email: | surabhi.bhatt@nm.org |
| Phone: | 312-472-6024 |
How Many Opiates Should we Prescribe for Pain in Patients Undergoing Knee Arthroscopies and ACL Reconstructions?
The purpose of the study is to determine if opiates are required to achieve adequate
analgesia after knee arthroscopy and ACL reconstruction in outpatient surgery.
The investigators hypothesize that patients are frequently prescribed more opiates than are
needed after surgery, resulting in excess medications that are at risk for misuse, diversion
and contribution to the opioid epidemic.
analgesia after knee arthroscopy and ACL reconstruction in outpatient surgery.
The investigators hypothesize that patients are frequently prescribed more opiates than are
needed after surgery, resulting in excess medications that are at risk for misuse, diversion
and contribution to the opioid epidemic.
Perioperative pain management is an important aspect of quality patient care. Opioid pain
medications are increasingly being used for pain control, with the United States writing over
250 million prescriptions for painkillers per year. Increased usage has led to unintended
negative consequences for individuals and society. It is estimated that 46 people die each
day from an overdose of prescription painkillers, and individual use can lead to the
development of tolerance and worse treatment outcomes. Further issues arise when opioids are
misused, it is estimated that non-therapeutic use has increased three fold in recent years.
In the United States alone in 2006 the estimated total cost of opioid prescription misuse was
$53.4 billion, of which $42 billion was attributed to lost productivity, $8.2 billion to
criminal justice cost and the remainder drug abuse treatment and medical complications. The
federal government has recognized this epidemic and raised a call for clinicians to more
responsibly prescribe opiate pain medications.
Opiate use has increased in recent years, from 2000-2010 the use of opiates in office based
visits nearly doubled from 11.3% to 19.6% whereas there was no change in the prescribing of
non-opioid pharmacotherapies. Further, when specifically looking at new musculoskeletal pain
visits, one half resulted in pharmacologic treatment, with the prescribing of non-opioid
pharmacotherapies decreasing from 38% to 29% from 2000 to 2010, respectively. The clinical
use of opioids for post-operative pain control has also been linked to the opioid epidemic
and risk of future abuse. Legitimate opioid use before high school graduation is
independently associated with a 33% increased risk of future misuse after high school.
It has been estimated that orthopedic surgeons prescribe 7.7% of all opioids in the United
States.Special attention needs to be paid to the amount of opioid pain medications orthopedic
surgeons prescribe to patients after ambulatory surgery, there is considerable variability
among surgeon and procedure in regards to the amount of opioids to prescribe with many
patients left with excess unused medication.An analysis of 250 patients undergoing outpatient
upper extremity surgery found that on average patients consumed 10 opioid pills, with 19
pills left over and a total of 4,639 pills going unused in the cohort. Leftover prescription
opioids are at risk for diversion to family and friends for nonmedical use. Further studies
are needed to quantify the amount of opioids to prescribe for specific orthopedic procedures
to limit excess narcotic use, misuse, diversion and contribution to the opioid epidemic.
medications are increasingly being used for pain control, with the United States writing over
250 million prescriptions for painkillers per year. Increased usage has led to unintended
negative consequences for individuals and society. It is estimated that 46 people die each
day from an overdose of prescription painkillers, and individual use can lead to the
development of tolerance and worse treatment outcomes. Further issues arise when opioids are
misused, it is estimated that non-therapeutic use has increased three fold in recent years.
In the United States alone in 2006 the estimated total cost of opioid prescription misuse was
$53.4 billion, of which $42 billion was attributed to lost productivity, $8.2 billion to
criminal justice cost and the remainder drug abuse treatment and medical complications. The
federal government has recognized this epidemic and raised a call for clinicians to more
responsibly prescribe opiate pain medications.
Opiate use has increased in recent years, from 2000-2010 the use of opiates in office based
visits nearly doubled from 11.3% to 19.6% whereas there was no change in the prescribing of
non-opioid pharmacotherapies. Further, when specifically looking at new musculoskeletal pain
visits, one half resulted in pharmacologic treatment, with the prescribing of non-opioid
pharmacotherapies decreasing from 38% to 29% from 2000 to 2010, respectively. The clinical
use of opioids for post-operative pain control has also been linked to the opioid epidemic
and risk of future abuse. Legitimate opioid use before high school graduation is
independently associated with a 33% increased risk of future misuse after high school.
It has been estimated that orthopedic surgeons prescribe 7.7% of all opioids in the United
States.Special attention needs to be paid to the amount of opioid pain medications orthopedic
surgeons prescribe to patients after ambulatory surgery, there is considerable variability
among surgeon and procedure in regards to the amount of opioids to prescribe with many
patients left with excess unused medication.An analysis of 250 patients undergoing outpatient
upper extremity surgery found that on average patients consumed 10 opioid pills, with 19
pills left over and a total of 4,639 pills going unused in the cohort. Leftover prescription
opioids are at risk for diversion to family and friends for nonmedical use. Further studies
are needed to quantify the amount of opioids to prescribe for specific orthopedic procedures
to limit excess narcotic use, misuse, diversion and contribution to the opioid epidemic.
Inclusion Criteria:
- All patients presenting to Northwestern Memorial Hospital (NMH) or to a Northwestern
orthopaedic surgery faculty member's clinic undergoing knee arthroscopy with meniscus
repair and/or debridement
- 18 years old or greater
- Ability to read and speak English
Exclusion Criteria:
- Revision surgery
- Oncologic surgery
- Arthroscopic knee surgery that involves procedures other than ACL or the meniscus (i.e
PCL, LCL, MPFL)
- Patients currently taking narcotics, chronic pain management patients, history of
substance abuse
- Adults unable to consent
- Individuals who are not yet adults (infants, children, teenagers)
- Pregnant women
- Prisoners
- Patients currently taking narcotics, chronic pain management patients, history of
substance abuse
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