Opioids may not be needed after knee surgery

TUESDAY, Nov. 23, 2021 (HealthDay News) – Addictive opioid painkillers aren’t the only option for patients seeking relief after anterior cruciate ligament (ACL) knee reconstruction, researchers say.

As the United States grapples with rapidly rising levels of opioid abuse and drug overdose deaths, the findings may come as good news.

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

“Opioid drugs can be useful for managing high levels of pain when prescribed appropriately,” 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 improperly or in high doses, opioids can have side effects, including drowsiness, confusion, shortness of breath and even death.”

Drug overdose deaths in the United States are the highest ever, the U.S. Centers for Disease Control and Prevention said this month, with 100,000 drug-related deaths between April 2020 and April 2021. a jump of 30% compared to the previous year. And more than three-quarters of these deaths are due to opioid use alone.

For many people, opioid addiction begins with the legal use of prescription painkillers after surgery. Orthopedic and spinal conditions account for nearly 28 percent of all opioid prescriptions issued in the United States, the research team said in background notes. This has led experts to look for safer ways to minimize postoperative 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 bearable while eliminating opioid use,” he added.

The findings were published online recently at American Journal of Sports Medicine.

For the study, the Okoroha team tested its pain management protocol with 34 patients who underwent ACL surgery between February 2019 and January 2020.

All were offered opioid-free pain medications after surgery, including NSAIDs, acetaminophen, and muscle relaxants. Pain levels 10 days after the start of pain treatment were compared with those of 28 other opioid-treated patients.

The researchers found that pain relief was the same in both groups, with no noticeable differences in side effects (no risk of addiction), even after taking into account age, gender, and body mass index (a standard indicator of obesity status).

The findings come as no surprise to an expert who was not part of Okoroha’s research team.

“I actually have reconstructed both of my ACLs, so I know the associated pain well,” said Dr. David Katz, director of the Yale University Prevention Research Center in New Haven, Connecticut. “I believe I used opioids for a day or two and then quickly switched to non-opioid treatment.”

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

“Based on personal experience, I’m not at all surprised that opioids can be skipped from the regimen while maintaining comparable pain management,” he added.

However, Katz expressed some reservations about the approach of the present study.

“The regime in this study doesn’t impress me that much, to be brutally honest,” he said. “Avoids opioids, which can cause dangerous addiction, but includes benzodiazepines (Valium), which can cause dangerous addiction. And there is no mention of non-drug options, such as the cooling compress I described, “Katz said.

“As the place begins to heal, there is a case of a gentle massage. True “multimodal” pain relief is not just different drugs. It should include non-drug options that also work, “he suggested.

However, Katz did not completely reject the work. “In general, opioids are used excessively until much of the chronic pain is treated. So there is certainly a need to broadcast any progress that can help deal with these double threats, “he said.

More info

There is more about opioids and their associated risks at the US Centers for Disease Control and Prevention.

SOURCES: Kelechi R. Okoroha, MD, Orthopedic Surgeon and Sports Injury Specialist, Department of Sports Medicine, Mayo Clinic, Minneapolis; David Katz, MD, MPH, Director, Yale University Prevention Research Center, New Haven, Connecticut; American Journal of Sports Medicine, October 20, 2021, online