Orthopedic surgery patients can recover just as well without using opioid painkillers


According to a study by McMaster University and Hamilton Health Sciences (HHS) published by the Journal of the American Medical Association (JAMA).

The results of the study showed that by prescribing a combination of three non-opioid painkillers to patients, the researchers were able to reduce the amounts of opioids consumed by about ten times over a six-week postoperative period, without changing their pain level.

Co-Principal Investigator Olufemi Ayeni and his team gleaned their findings by enrolling 193 patients between March 2021 and March 2022 at three Hamilton hospitals, including HHS’ 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 receiving standard opioid painkillers or a non-opioid group (93) receiving combination therapy of naproxen, acetaminophen, and pantoprazole and an infographic education for patients. The non-opioid group had access to opioid medication if needed for pain relief. Each patient undergoing outpatient arthroscopic knee or shoulder surgery was followed for six weeks after their operation.

After the six weeks, those in the control group had consumed 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 requested opioid medication after discharge. The difference in pain scores, patient satisfaction with care, and number of adverse events were not significantly different.

This study clearly shows that many of these surgical patients can be treated safely without opioid medication in a selected population. »

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

“Furthermore, by reducing the number of opioids prescribed, we can collectively reduce the development of a reservoir of unused drugs that can harm many people in society,” he said.

“According to one estimate, there are at least 100,000 of these surgeries in Canada each year, which means that changing prescribing practices to reduce opioid use can reduce patient exposure and, by extension, the potential for opioid addiction.

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

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

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

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


Journal reference:

NO PAin Investigators., (2022) Effect of a postoperative multimodal opioid-sparing protocol versus 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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