New Study Checks Opioid Math in Knee Arthroscopies

Following the curiosity of some visiting surgeons from Argentina, researchers from Washington University in St. Louis, Missouri, set out to examine the numbers on opioids and knee arthroscopy. Their work, “Opioid Consumption After Knee Arthroscopy,” appears in October 3, 2018 edition of The Journal of Bone and Joint Surgery.

Matthew V. Smith, M.D., with the Department of Orthopaedic Surgery at Washington University, explained his interest in this subject to OTW, “Our interest in this topic started several years ago after a conversation with two visiting surgeons from Argentina. They were surprised at how many opioid pills patients in the United States were given after surgery. We were surprised by how few opioid pills they prescribed in their country.”

“After a literature review of opioid use after knee surgery, we recognized that there was little data to guide orthopaedic surgeons on the appropriate number of pills to prescribe after knee surgery. With the opioid epidemic burgeoning in the United States, we recognized that we needed better data on what patients actually use after surgery to guide responsible opioid prescribing patterns.”

“Since knee arthroscopy is one of the most common procedures performed in the United States, we thought that it would be important to determine how many opioid pills patients use after this surgery.”

The authors described their study as follows, “A prospective observational study of 221 patients was conducted in patients undergoing outpatient knee arthroscopy for meniscal repair, partial meniscectomy, debridement, chondroplasty, or loose body removal. Participants recorded their daily opioid consumption in a postoperative pain diary. Total opioid consumption was calculated from counts of remaining pills at the 2-week and 6-week postoperative office visits.”

Regarding their findings, Dr. Smith commented to OTW, “The median number of hydrocodone-equivalent pills taken after knee arthroscopy was 7 with nearly 50% of patients taking fewer than 5 pills and 80% of patients took fewer than 20 pills. Patients undergoing meniscus repair, smokers and patients taking opioid medications prior to surgery required more opioid pills.”

“Opioid prescriptions for knee arthroscopy can be limited to less than 20 pills for most patients. In fact, most patients (60%) would do fine with 10 pills or fewer but this would increase the burden of refills.”

“With over 600,000 knee arthroscopies performed in the United States, an excess of just 10 opioid pills per patient would result in 6 million extra opioid pills for potential diversion into the community. Our hope is that orthopaedic surgeons can use this data to balance post-operative pain control with responsible prescribing habits to reduce excess opioids available for abuse.”