Knee surgery: patient education, lower quantities curb opioid use

  • Farley KX & al.
  • JAMA
  • 25 Jun 2019

  • International Clinical Digest
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Takeaway

  • Prescribing fewer opioid tablets after surgery reduced the amount of opioids consumed, the number of days of opioid use, and reports of constipation and fatigue among patients undergoing anterior cruciate ligament (ACL) reconstruction.
  • Patient education was tied to lower duration and quantity of postoperative opioid use.

Why this matters

  • Prescribing larger amounts of opioids after surgery is associated with an increased risk of opioid addiction.

Study design

  • Study of 264 adolescent and adult patients undergoing ACL reconstruction, receiving fixed-dose oxycodone-acetaminophen (Percocet) during 2016-2018; patients received:
    • 50 tablets and no education (n=109);
    • 30 tablets and no education (n=77); or
    • 30 tablets and education (n=78).
  • Funding: None disclosed.

Key results

  • Patients who received 50 tablets vs those who received 30 tablets and no education reported higher:
    • Opioid consumption (mean, 25.4 vs 15.6 tablets; P<.001>
    • number of postoperative days of opioid use (5.8 vs 4.5 days; P=.03);
    • rates for constipation (55.0% vs 37.7%; P=.02) and fatigue (16.5% vs 6.5%; P=.04).
  • Patients who received 30 tablets and education vs those who received 30 tablets and no education:
    • Consumed fewer tablets (mean, 12.4 vs 15.6; P=.02);
    • Used opioids for fewer postoperative days (3.5 vs 4.5 days; P=.02).

Limitations

  • Observational, monocentric design; recall bias.

Coauthored with Antara Ghosh, PhD

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