Opioids Might Not Be Needed After Knee Surgery

By Alan Mozes
HealthDay Reporter

TUESDAY, Nov 23, 2021 (HealthDay News) — Addictive opioid painkillers aren’t the one choice for sufferers searching for aid following anterior cruciate ligament (ACL) knee reconstruction, researchers say.

As the United States wrestles with skyrocketing charges of opioid abuse and drug overdose deaths, the findings might come as excellent news.

After ACL surgical procedure, Advil and different nonsteroidal anti-inflammatory medication (NSAIDs), acetaminophen (Tylenol) and muscle relaxers seem to supply the identical diploma of ache management to sufferers as prescription opioids like morphine, hydrocodone or oxycodone, the small research concluded.

“Opioid medicines could be useful in managing excessive ranges of ache when appropriately prescribed,” defined research co-author Dr. Kelechi Okoroha. He is an orthopedic surgeon and sports activities damage specialist with the Mayo Clinic in Minneapolis.

“However, when used for lengthy durations of time, opioids could be addicting,” Okoroha cautioned. And “when used incorrectly, or in excessive doses, opioids can have unintended effects, together with drowsiness, confusion, slowed respiratory and even demise.”

Drug overdose deaths within the United States are at an all-time excessive, the U.S. Centers for Disease Control and Prevention reported this month — 100,000 drug-related fatalities between April 2020 and April 2021. This represents a 30% leap over the prior 12 months. And greater than three-quarters of those deaths have been attributed to opioid use alone.

For many individuals, opioid habit begins with reputable prescription painkiller use after surgical procedure. Orthopedic and backbone circumstances account for practically 28% of all opioid prescriptions issued within the United States, the analysis staff mentioned in background notes. That has led consultants to hunt safer technique of minimizing post-surgical discomfort.

ACL surgical procedure is a standard operation, and “knee surgical procedure could cause excessive ranges of ache,” Okoroha mentioned.

But the excellent news is that the brand new research exhibits that “with applicable multimodal administration, we will make this ache tolerable,” whereas eliminating opioid use, he added.

The findings have been printed on-line lately within the American Journal of Sports Medicine.

For the research, Okoroha’s staff examined their ache administration protocol with 34 sufferers who underwent ACL surgical procedure between February 2019 and January 2020.

All have been provided opioid-free ache medicines post-op, together with NSAIDs, acetaminophen and muscle relaxers. Pain ranges 10 days after ache therapy started have been in contrast with these of 28 different sufferers handled with an opioid medicine.

The investigators decided that ache aid was the identical throughout each teams, with no considerable variations by way of unintended effects (habit threat apart), even after accounting for age, gender and physique mass index (a typical indicator of weight problems standing).

The findings do not shock one knowledgeable who was not a part of Okoroha’s research staff.

“I’ve truly had each of my ACLs reconstructed, so I do know the related ache effectively,” mentioned Dr. David Katz, director of the Yale University Prevention Research Center, in New Haven, Conn. “I consider I used opioids for a day or two each instances, after which rapidly transitioned to non-opioid therapy.”

That therapy went past medicine. “An automated, cooling compress across the surgical web site offered the best aid,” mentioned Katz.

“Based on private expertise, I’m not in any respect stunned that opioids could be omitted from the routine, whereas preserving comparable ache administration,” he added.

Nevertheless, Katz expressed some reservations in regards to the present research’s strategy.

“The routine on this research doesn’t impress me all that a lot, to be brutally sincere,” he mentioned. “It avoids opioids, which could be dangerously habit-forming, however features a benzodiazepine (Valium), which could be dangerously habit-forming. And there is no such thing as a point out of non-medication choices, such because the cooling compress I described,” Katz famous.

“As the positioning begins to heal, there’s a case for mild therapeutic massage as effectively. Truly ‘multimodal’ ache aid isn’t just completely different medicines. It ought to embrace non-medication choices that work, too,” he steered.

Still, Katz did not dismiss the work solely. “In normal, opioids are overused, whereas plenty of persistent ache is undertreated. So there may be definitely a must broadcast any advance that may assist tackle these twin threats,” he mentioned.

More info

There’s extra on opioids and associated dangers on the U.S. Centers for Disease Control and Prevention.

SOURCES: Kelechi R. Okoroha, MD, orthopedic surgeon and sports activities damage specialist, division of sports activities drugs, Mayo Clinic, Minneapolis; David Katz, MD, MPH, director, Yale University Prevention Research Center, New Haven, Conn.; American Journal of Sports Medicine, Oct. 20, 2021, on-line