Patient Education Reduces Postop Opioid Use

A new study presented at a recent University of Pittsburgh Medical Center Sports Medicine Meeting suggests that educating patients before surgery about appropriate postop opioid use could help in the battle against opioid addiction.

Because many opioid addictions start with an opioid prescription after surgery, there has been a push to find better ways to provide adequate post-operative pain control while at the same time minimizing the number of unused pills after surgery.

To see how effective patient education would be to this end, Alexis Colvin, M.D., associate professor of orthopedics at the Icahn School of Medicine at Mount Sinai and chief medical officer for the United States Tennis Association, and colleagues investigated opioid use in patients after undergoing arthroscopic meniscectomy.

Patients 18 years and older were identified from a group of five attending surgeons performing isolated arthroscopic unicompartmental meniscectomy. Sixty-two patients were recruited and assigned to either Group 1 (32; no pre-operative education) or Group 2 (24; received pre-operative education).

Those in group 2 received a formalized three-minute overview from a physician on both appropriate usage of opioid narcotics as well as options for non-narcotic post-operative analgesia.

Patients were surveyed post-surgery by phone one, two, three and four weeks after surgery to determine how many opioid pills were taken each week. According to the data, patients in Group 1 used an average of 16.71 (95% CI, 9.67–23.75) opioid pills after surgery while patients in Group 2 used an average 3.21 (95% CI, 1.78–6.06) opioids after surgery.

Patients in Group 2 used 13.5 less opioid pills (p = 0.001) representing a 420.0% decrease in post-operative opioid consumption over a four-week course. Seven (21.9%) patients in Group 1 continued to take opioid pills four weeks after surgery, while only 1 (4.2%) patient in Group 2 did the same.

Overall, Colvin and colleagues found that pre-operative patient education regarding appropriate usage of opioid and options for non-narcotic analgesia significantly decreases post-operative opioid consumption and the duration which patients take opioid pills after arthroscopic meniscectomy.

They added that pre-operative education is quick and inexpensive method to decrease post-operative opioid prescription requirements.

Colvin told OTW that the most important elements any patient education should include are:

• Counseling about treating mild versus severe pain differently. For instance, mild pain after knee meniscectomy can be treated effectively with non-narcotic pain medication.
• The use of non-medication therapies for pain such as ice.
• Using peer pressure in a positive way by letting patients know that the majority of patients who undergo a similar surgery do not at all or only use very limited narcotic medications postop.

On whether doctors should also be limiting how a large a prescription they prescribe, she said, “Absolutely. Patients are less likely to take opioids if they are given a fewer amount. Furthermore, it reduces the number of narcotics that can be diverted to non-therapeutic use.”