Opioids May Not Be Wanted After Knee Surgical procedure


By Alan Mozes
HealthDay Reporter

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

As the US wrestles with skyrocketing charges of opioid abuse and drug overdose deaths, the findings could 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 examine concluded.

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

“Nevertheless, when used for lengthy durations of time, opioids may be addicting,” Okoroha cautioned. And “when used incorrectly, or in excessive doses, opioids can have negative effects, together with drowsiness, confusion, slowed respiratory and even loss of life.”

Drug overdose deaths in the US are at an all-time excessive, the U.S. Facilities for Illness Management and Prevention reported this month — 100,000 drug-related fatalities between April 2020 and April 2021. This represents a 30% soar over the prior 12 months. And greater than three-quarters of those deaths had been attributed to opioid use alone.

For many individuals, opioid habit begins with authentic prescription painkiller use after surgical procedure. Orthopedic and backbone circumstances account for almost 28% of all opioid prescriptions issued in the US, the analysis staff stated 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 may cause excessive ranges of ache,” Okoroha stated.

However the excellent news is that the brand new examine exhibits that “with applicable multimodal administration, we are able to make this ache tolerable,” whereas eliminating opioid use, he added.

The findings had been printed on-line not too long ago within the American Journal of Sports activities Medication.

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

All had been supplied opioid-free ache medicines post-op, together with NSAIDs, acetaminophen and muscle relaxers. Ache ranges 10 days after ache remedy started had 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 negative effects (habit threat apart), even after accounting for age, gender and physique mass index (an ordinary indicator of weight problems standing).

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

“I’ve truly had each of my ACLs reconstructed, so I do know the related ache nicely,” stated Dr. David Katz, director of the Yale College Prevention Analysis Heart, in New Haven, Conn. “I consider I used opioids for a day or two each occasions, after which shortly transitioned to non-opioid remedy.”

That remedy went past medicine. “An automatic, cooling compress across the surgical website supplied the best aid,” stated Katz.

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

Nonetheless, Katz expressed some reservations concerning the present examine’s strategy.

“The routine on this examine doesn’t impress me all that a lot, to be brutally sincere,” he stated. “It avoids opioids, which may be dangerously habit-forming, however features a benzodiazepine (Valium), which may be dangerously habit-forming. And there’s no 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 light therapeutic massage as nicely. Really ‘multimodal’ ache aid is not only completely different medicines. It ought to embody non-medication choices that work, too,” he recommended.

Nonetheless, Katz did not dismiss the work solely. “Usually, opioids are overused, whereas a variety of power ache is undertreated. So there’s definitely a have to broadcast any advance that may assist deal with these twin threats,” he stated.

Extra info

There’s extra on opioids and associated dangers on the U.S. Facilities for Illness Management 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 College Prevention Analysis Heart, New Haven, Conn.; American Journal of Sports activities Medication, Oct. 20, 2021, on-line

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