Summary

Institution of a standardized multimodal analgesia protocol significantly decreased the amount of opioids dispensed after common arthroscopic procedures while still providing adequate pain relief for patients with no increased demand for opioid refills postoperatively.

Abstract

Purpose

To evaluate the implementation of a standardized multimodal analgesic protocol to decrease the amount of opioids prescribed at the time of surgery and the total amount of opioids dispensed postoperatively.


Study Design

Retrospective review

Methods

Patients who had undergone meniscectomy, rotator cuff repair and ACL reconstruction were identified by CPT code 12 months prior to and 6 months after the initiation of a standardized multimodal analgesic postoperative pain protocol. Records were retrospectively reviewed to extract demographic data, the amount of opioids prescribed at the time of surgery, amount and frequency of opioid refills, and call-ins regarding pain medication or its side effects. Students t test and chi squared? ANOVA? Were used to evaluate differences in opioid prescriptions and significance was set to p<0.05.

Results

The average amount of opioids prescribed at the time of surgery decreased from 63.45 to 22.3 pills (64.9%, p < 0.01) for meniscectomy, from 73.1 to 39.7 (45.8%, p < 0.01) for ACL reconstruction, and from 75.6 to 39.8 (47.4%, p < 0.01) for rotator cuff repair. The percentage of patients receiving a refill of opioids in the post-operative period also decreased for all groups: 13% to 4% (p < 0.01) in the meniscectomy group, 29.2% to 11.4% (p < 0.01) in ACL reconstruction, and 47.3% to 24.4% (p < 0.01) in the rotator cuff repair group. There was no significant difference in patients calls regarding their pain medication or its side effects (p=0.01).

Conclusions

Institution of a standardized multimodal analgesia protocol significantly decreased the amount of opioids dispensed after common arthroscopic procedures with no increased demand for refills. In the face of the opioid epidemic, this protocol serves as an example of a way for providers to decrease the amount of opioids dispensed after surgery while still providing patients with adequate pain relief.