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"Monitoring Postoperative Opioid Use Following Simple Arthroscopic Meni" by Vance Gardner, David Gazzaniga et al.
Monitoring Postoperative Opioid Use Following Simple Arthroscopic Meniscectomy: A Performance-Improvement Strategy for Prescribing Recommendations and Community Safety.
Vance Gardner, Hoag Orthopedics, Irvine, California
David Gazzaniga, Hoag Orthopedics, Irvine, California
Michael Shepard, Hoag Orthopedics, Irvine, California
Robert Grumet, Hoag Orthopedics, Irvine, California
Benjamin Rubin, Hoag Orthopedics, Irvine, California
Camille Bray, Hoag Orthopedics, Irvine, California
Carlos Prietto, Hoag Orthopedics, Irvine, California
JB JS Open Access
Background: Orthopaedic surgeons are confronted with a difficult dilemma: managing acute pain postoperatively and balancing the risk of prescription opioid use. To our knowledge, a prospective performance-improvement project providing opioid-prescription recommendations based on the actual amounts of usual and customary medication consumed following simple knee meniscectomy has not been described.
Methods: One hundred and two patients undergoing arthroscopic knee meniscectomy prospectively recorded postoperative pain medications in a pain journal. Arthroscopic procedures were performed at 2 centers by 9 fellowship-trained senior surgeons. Various usual and customary prescribing protocols were observed, and the amount of medication consumed was recorded. Prescription and over-the-counter pain medication, quantity, frequency, and visual analog scale (VAS) pain scores were collected.
Results: One hundred and two patients filled a prescription opioid medication and were included in the study. A total of 3,765 pills were prescribed, and a total of 573.5 were consumed. For the 102 patients who filled a prescription, the average time consuming opioid medication was 2 ± 2 days (range, 0 to 13 days) postoperatively. No cases of persistent use were recorded. Of the 102 patients who filled a prescription, 29.4% did not take any prescription opioids postoperatively. A total of 3,191.5 pills (or 22,183.75 morphine milligram equivalents [MME]) were unused and were potentially available to the community.
Conclusions: Following simple knee arthroscopy, the amount of prescribed opioid medication exceeds the need for postoperative pain management. In general, 68% of patients require a maximum of 13 pills postoperatively for 6 days. Surgeons should adjust prescribing standards accordingly to limit the amount of prescription opioids available to the community. Furthermore, a comprehensive response to include increased patient screening and monitoring as well as opioid use and disposal education is recommended.
Orthopedics & Sports Medicine
Gardner, Vance; Gazzaniga, David; Shepard, Michael; Grumet, Robert; Rubin, Benjamin; Dempewolf, Michael; Bray, Camille; and Prietto, Carlos, "Monitoring Postoperative Opioid Use Following Simple Arthroscopic Meniscectomy: A Performance-Improvement Strategy for Prescribing Recommendations and Community Safety." (2018). Articles, Abstracts, and Reports. 1271.