Multimodal Analgesia Reduces Opioid Consumption

A new study is giving insight into the relationship between non-steroidal anti-inflammatory drugs (NSAIDs) and use of opioids following surgery. 



Investigators presented the study, which found that patients taking NSAIDs in combination with opioids took less opioids but had a similar pain levels as those who received just opioids, at the 2019 American Orthopedic Society of Sports Medicine's Annual Meeting.

"The current opioid epidemic demands physicians seek ways to decrease patients' requirements of narcotic medications without sacrificing their postoperative comfort level," said lead investigators Kamali Thompson, MD, of the New York University Hospital for Joints Diseases.

In order to determine how opioid intake differed among patients received an NSAID and rescue opioids and those prescribed opioids alone, investigators conducted a study examining the use in 40 patients who had recently undergone arthroscopic surgery.

Following surgery, the group of 40 patients were randomized to receive either ibuprofen 600 mg and a 10-pill rescue prescription of Percocet 5/325 mg (20) or Percocet 5/325 mg (20). The primary outcomes of the study were the amount of Percocet tablets used in the first week and visual analogue scale (VAS) on postoperative days 1, 4 and, 7.

The mean age of the patient population was 35.08 (SD, 8.48) and they were enrolled between Dec. 2017 and May 2018. Investigators used t-tests and bivariate analysis for correlation when performing their statistical analysis. 



Upon analysis, investigators found total amount of opioid consumption was statically significantly lower in the multimodal group compared to the opioid group and in Percocet consumption between postoperative days 1 through 4. Investigators noted no differences in VAS at any point between the 2 groups.

In terms of adverse events, 1 patient experienced dizziness in the ibuprofen cohort on postoperative day 1. Additionally, 2 patients in the Percocet cohort experienced nausea and vomiting on postoperative day 1 and postoperative day 4.

Within their conclusion, investigators wrote that the results demonstrate the ability of multimodal analgesia using NSAIDs to significantly reduce postoperative narcotic consumption. Pointing to the similar pain levels, investigators suggest there is safer, more efficient ways of prescribing opioids to patients. 



"It is possible to alleviate postoperative pain with lower amounts of opioids than are currently being prescribed," Thompson said. "The public health crisis of opioid abuse requires an immediate solution beginning with the reduction of post-operative narcotics distribution."

This study, titled “Opioid Use is Reduced in Patients Treated with NSAIDS After Arthroscopic Shoulder Instability Repair: A Randomized Study,” was presented at the 2019 American Orthopedic Society of Sports Medicine's Annual Meeting.