Study: Addictive Opioids Not Recommended After ACL Knee Surgery


Addictive opioid pain relievers are not the only option for patients seeking relief after knee reconstruction of the anterior cruciate ligament or ACL, according to the researchers.

As the United States grapples with rising rates of opioid abuse and drug overdose deaths, the results may be good news.

After ACL surgery, Advil, and other nonsteroidal anti-inflammatory drugs, or NSAIDs, acetaminophen – Tylenol – and muscle relaxants appear to offer the same degree of pain control to patients as prescription opioids like morphine , hydrocodone or oxycodone, the small study concluded. .

“Opioid medications can be helpful in managing high levels of pain when prescribed correctly,” said study co-author Dr. Kelechi Okoroha. He is an orthopedic surgeon and sports injury specialist at the Mayo Clinic in Minneapolis.

“However, when used for long periods of time, opioids can be addictive,” Okoroha warned. And “when used incorrectly or in high doses, opioids can have side effects, including drowsiness, confusion, slowed breathing and even death.”

Drug overdose deaths in the United States have reached an all-time high, the United States Centers for Disease Control and Prevention reported this month – 100,000 drug-related deaths between April 2020 and April 2021.

This represents a 30% jump from the previous year. And more than three-quarters of those deaths have been attributed to opioid use alone.

For many people, opioid addiction begins with the legitimate use of prescription pain relievers after surgery.

Orthopedic and spinal conditions account for nearly 28% of all opioid prescriptions issued in the United States, the research team said in briefing notes. This has led experts to seek safer ways to minimize post-surgical discomfort.

ACL surgery is a common operation and “knee surgery can cause high levels of pain,” Okoroha said.

But the good news is that the new study shows that “with proper multimodal management, we can make this pain tolerable” while also eliminating opioid use, he added.

The results were recently published in the American Journal of Sports Medicine.

For the study, Okoroha’s team tested their pain management protocol with 34 patients who had ACL surgery between February 2019 and January 2020.

All were offered non-opioid pain relievers after the operation, including NSAIDs, acetaminophen and muscle relaxants. Pain levels 10 days after starting pain treatment were compared to 28 other patients treated with an opioid drug.

The investigators determined that pain relief was the same in both groups, with no appreciable difference in terms of side effects – risk of addiction aside – even after controlling for age, gender, and condition. body mass index, a standard indicator of obesity.

The results did not surprise an expert who was not part of the Okoroha study team.

“In fact, both of my ACLs were reconstructed, so I’m familiar with the associated pain,” said Dr. David Katz, director of the Yale University Prevention Research Center, in New Haven, Conn.

“I believe I used opioids for a day or two both times and then quickly switched to non-opioid treatment,” Katz said.

This treatment went beyond medication. “An automated cooling pad around the surgical site provided the greatest relief,” Katz said.

“From my personal experience, I am not at all surprised that opioids can be omitted from the regimen while still maintaining comparable pain management,” he added.

Nonetheless, Katz expressed some reservations about the current study’s approach.

“The diet in this study doesn’t impress me that much, to be bluntly honest,” he said. “She avoids opioids, which can be dangerous for addiction, but includes a benzodiazepine [Valium], which can be dangerous for addiction. And there is no mention of non-drug options, such as the cooling compress that I described, ”Katz noted.

“As the site begins to heal, there is also a need for a gentle massage. True “multimodal” pain relief doesn’t just consist of different medications. It should also include non-drug options that also work, ”he suggested.

Still, Katz didn’t completely reject the job.

“In general, opioids are overused, while a lot of chronic pain is under-treated. So there is certainly a need to disseminate any advancement that can help deal with these dual threats,” he said.

More information

There is more information on opioids and the risks associated with the United States Centers for Disease Control and Prevention.

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