Opioids Might Not Be Needed After Knee Surgery

TUESDAY, Nov 23, 2021 (HealthDay News) -- Addictive opioid painkillers aren't the lone enactment for patients seeking alleviation pursuing anterior cruciate ligament (ACL) knee reconstruction, researchers say.

As the United States wrestles with skyrocketing rates of opioid maltreatment and cause overdose deaths, the findings whitethorn travel arsenic bully news.

After ACL surgery, Advil and different nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (Tylenol) and musculus relaxers look to connection the aforesaid grade of symptom power to patients arsenic medicine opioids similar morphine, hydrocodone oregon oxycodone, the tiny survey concluded.

"Opioid medications tin beryllium adjuvant successful managing precocious levels of symptom erstwhile appropriately prescribed," explained survey co-author Dr. Kelechi Okoroha. He is an orthopedic surgeon and sports wounded specializer with the Mayo Clinic successful Minneapolis.

"However, erstwhile utilized for agelong periods of time, opioids tin beryllium addicting," Okoroha cautioned. And "when utilized incorrectly, oregon successful precocious doses, opioids tin person broadside effects, including drowsiness, confusion, slowed breathing and adjacent death."

Drug overdose deaths successful the United States are astatine an all-time high, the U.S. Centers for Disease Control and Prevention reported this period — 100,000 drug-related fatalities betwixt April 2020 and April 2021. This represents a 30% leap implicit the anterior year. And much than three-quarters of these deaths were attributed to opioid usage alone.

For galore people, opioid addiction starts with morganatic medicine painkiller usage aft surgery. Orthopedic and spine conditions relationship for astir 28% of each opioid prescriptions issued successful the United States, the probe squad said successful inheritance notes. That has led experts to question safer means of minimizing post-surgical discomfort.

ACL country is simply a communal operation, and "knee country tin origin precocious levels of pain," Okoroha said.

But the bully quality is that the caller survey shows that "with due multimodal management, we tin marque this symptom tolerable," portion eliminating opioid use, helium added.

The findings were published online precocious successful the American Journal of Sports Medicine.

For the study, Okoroha's squad tested their symptom absorption protocol with 34 patients who underwent ACL country betwixt February 2019 and January 2020.

All were offered opioid-free symptom medicines post-op, including NSAIDs, acetaminophen and musculus relaxers. Pain levels 10 days aft symptom attraction began were compared with those of 28 different patients treated with an opioid medication.

The investigators determined that symptom alleviation was the aforesaid crossed some groups, with nary appreciable differences successful presumption of broadside effects (addiction hazard aside), adjacent aft accounting for age, sex and assemblage wide scale (a modular indicator of obesity status).

The findings don't astonishment 1 adept who was not portion of Okoroha's survey team.

"I person really had some of my ACLs reconstructed, truthful I cognize the associated symptom well," said Dr. David Katz, manager of the Yale University Prevention Research Center, successful New Haven, Conn. "I judge I utilized opioids for a time oregon 2 some times, and past rapidly transitioned to non-opioid treatment."

That attraction went beyond medication. "An automated, cooling compress astir the surgical tract provided the top relief," said Katz.

"Based connected idiosyncratic experience, I americium not astatine each amazed that opioids tin beryllium omitted from the regimen, portion preserving comparable symptom management," helium added.

Nevertheless, Katz expressed immoderate reservations astir the existent study's approach.

"The regimen successful this survey does not impressment maine each that much, to beryllium brutally honest," helium said. "It avoids opioids, which tin beryllium dangerously habit-forming, but includes a benzodiazepine (Valium), which tin beryllium dangerously habit-forming. And determination is nary notation of non-medication options, specified arsenic the cooling compress I described," Katz noted.

"As the tract starts to heal, determination is simply a lawsuit for gentle massage arsenic well. Truly 'multimodal' symptom alleviation is not conscionable antithetic medications. It should see non-medication options that work, too," helium suggested.

Still, Katz didn't disregard the enactment entirely. "In general, opioids are overused, portion a batch of chronic symptom is undertreated. So determination is surely a request to broadcast immoderate beforehand that tin assistance code these dual threats," helium said.

More information

There's much connected opioids and related risks astatine the U.S. Centers for Disease Control and Prevention.

SOURCES: Kelechi R. Okoroha, MD, orthopedic surgeon and sports wounded specialist, part of sports medicine, Mayo Clinic, Minneapolis; David Katz, MD, MPH, director, Yale University Prevention Research Center, New Haven, Conn.; American Journal of Sports Medicine, Oct. 20, 2021, online