Perioperative pain management and outcomes in patients who discontinued or continued pre-existing buprenorphine therapy

2021 ◽  
Vol 17 (7) ◽  
pp. 33-41
Author(s):  
Aamer Attaar, PharmD, BCPS ◽  
Molly Curran, PharmD, BCPS, BCCCP ◽  
Lyndsi Meyenburg, PharmD, BCPS ◽  
Richard Bottner, DHA, PA-C ◽  
Clarissa Johnston, MD ◽  
...  
Keyword(s):  
Outcome Measure ◽  
Primary Objective ◽  
Inclusion Criteria ◽  
Opioid Use ◽  
Pain Scores ◽  
High Quality Evidence ◽  
Post Operative Pain ◽  
Perioperative Pain Management ◽  
Control Post ◽  
Buprenorphine Treatment

Objective: This study compared opioid utilization and clinical outcomes in surgical patients receiving maintenance buprenorphine therapy who discontinued versus those who continued buprenorphine treatment perioperatively. Lack of high-quality evidence, conflicting results in previous studies, and the possible need for reinduction after discontinuing therapy present clinicians with the complicated dilemma of choosing the best strategy to control post-operative pain in patients receiving buprenorphine.Design: A multicenter, retrospective cohort study.Participants: Hospitalized patients between January 1, 2017 and December 12, 2019 who underwent any type of surgery, had a documentation of an outpatient buprenorphine prescription or inpatient order, and received buprenorphine for 5 or more days prior to the procedure were included.Main outcome measure(s): The primary objective was to compare mean 24-hour morphine milligram equivalent (MME) utilization post-operatively between patients who discontinued buprenorphine preoperatively versus those who continued therapy throughout the perioperative period.Results: Fifty-one patients met the inclusion criteria for this study. Of these, 42 patients were continued on buprenorphine through surgery, while nine patients had a documentation of discontinuation preoperatively. The 24-hour post-operative MME utilization (interquartile range) was 58.8 (18-100.8) in patients who continued therapy through surgery versus 152.6 (114.5-236) in patients who discontinued therapy preoperatively (p = 0.005). There were no significant differences in post-operative pain scores or length of stay between groups.Conclusion: Post-operative opioid use was significantly lower in patients who continued buprenorphine compared with those who discontinued buprenorphine preoperatively. 

The effect of a scheduled regimen of acetaminophen and ibuprofen on opioid use following cesarean delivery

2020 ◽  
Vol 48 (2) ◽  
pp. 153-156
Author(s):  
Dijana Poljak ◽  
Joseph Chappelle
Keyword(s):  
Cesarean Delivery ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Time Intervals ◽  
Pain Scores ◽  
Pain Medications ◽  
Post Operative Pain

AbstractObjectiveThe primary objective was to evaluate if the administration of ibuprofen and acetaminophen at regularly scheduled intervals impacts pain scores and total opioid consumption, when compared to administration based on patient demand.MethodsA retrospective chart review was performed comparing scheduled vs. as-needed acetaminophen and ibuprofen regimens, with 100 women included in each arm. Demographics and delivery characteristics were collected in addition to pain scores and total ibuprofen, acetaminophen and oxycodone use at 24, 48 and 72 h postoperatively.ResultsThe scheduled dosing group was found to have a statistically significant decrease in pain scores at all time intervals. Acetaminophen and ibuprofen usage were also noted to be higher in this group while narcotic use was reduced by 64%.ConclusionScheduled dosing of non-narcotic pain medications can substantially decrease opioid usage after cesarean delivery and improve post-operative pain.

scholarly journals POST OPERATIVE PAIN ASSESSMENT AND OPIOID USE FOLLOWING ACL RECONSTRUCTION WITH QUADRICEPS VERSUS HAMSTRING TENDON AUTOGRAFT IN ADOLESCENTS AND YOUNG ADULTS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0011
Author(s):  
Elizabeth S. Liotta ◽  
Edward G. Schleyer ◽  
Mininder S. Kocher ◽  
Lyle J. Micheli ◽  
Benton E. Heyworth
Keyword(s):  
Hamstring Tendon ◽  
Pain Level ◽  
Opioid Use ◽  
Nerve Blocks ◽  
Opioid Medication ◽  
Pain Scores ◽  
Hamstring Tendon Autograft ◽  
Post Operative Pain ◽  
Subjective Pain ◽  
Tendon Autograft

Background: The culture of opioid abuse in the United States has brought attention to prescribing habits, especially as recent studies identify practices within the post-operative period as a risk factor for the development of opioid dependence in adolescents. The current study sought to explore the concept of post-operative pain control and opioid use following ACL reconstruction (ACLR), one of the most common orthopaedic procedures for adolescents. Because recent adult studies have suggested that use of quadriceps tendon autograft, a graft choice that appears to be growing in popularity, may be associated with lower post-operative pain scores than other graft sources, we additionally investigated an ACLR cohort who received quad tendon autograft (ACLR-Q) and compared their pain scores and opioid use to a cohort with the more commonly used hamstring tendon autograft (ACLR-HS). Methods: Between 2016 and 2018, patients aged 12-25 years who underwent primary ACLR-Q or ACLR-HS by one of three surgeons at tertiary care children’s hospital, were provided a journal to record daily subjective pain level and medication use. To avoid confounder or outliers, patients with a history of diagnosed clinical pain syndrome or underlying psychiatric condition were excluded. Logbooks contained a scale from ‘0-5’ to record pain level prior to each medication use and tables to record information detailing medication consumption. All patients were prescribed Oxycodone, 5 mg, for post-operative pain control. Patient demographics, surgical data, and prescription information were extracted from the electronic medical record. A two-sided t-test was used to evaluate statistical relationships of data between graft types. Results: Logbooks of 54 patients (27 ACLR-Q and 27 ACLR-HS) were collected for analysis. Both cohorts had a similar mean age at time of surgery (ACLR-Q: 16.7 years, range: 12-23; ACLR-HS: 16.8 years, range: 13-21), and preponderance of female subjects (ACLR-Q: 83.3%; ACLR-HS: 81.5%). The mean weight of patients who received the quadriceps tendon autograft (mean: 68.8lbs, range: 47-121) was slightly heavier than for patients who received the hamstring tendon autograft (mean: 62.0lbs, range 49-93), but not to a significant degree (p=0.084). More meniscal injuries were identified in ACLR-HS patients (77.8% vs. ACLR-Q: 48.1%, p=0.024), and treated with a repair procedure more commonly (81% vs. ACLR-Q: 46.2%, p=<0.001), than with meniscectomy (19%; ACLR-Q: 46.2%, p=0.282). Mean length of surgery and tourniquet time were longer in the ACLR-Q (129, 115 minutes) group than ACLR-HS group (80, 54 minutes) (p=<0.001; p=<0.001). While intra-operative nerve blocks were utilized by a similar proportion of both cohorts (ACLR-Q: 88.9%, ACLR-HS: 85.2%, p:0.692), the ACLR-Q group received more adductor canal blocks (89.9% vs. 14.8%, p: <0.001), while the ACLR-HS group received more femoral nerve blocks most frequently (ACLR-Q: 63% vs. 0%, p: <0.001). For the overall study population, the mean number of pills per Oxycodone prescription was 47.5 (range: 30-84). ACLR-Q patients consumed an average of 14.6 opioid pain pills (range: 3-46) over a mean of 13.7 doses (range: 3-36), with the last dose occurring on day 4.4 (range: 1-13). ACLR-HS patients consumed an average of 16.9 opioid pain pills (range: 0-39) over a mean of 14.0 doses (0-36), with the last dose occurring on day 3.7 (range: 0-13). There were no significant differences seen between number of pills consumed (p=0.387), number of doses (p=0.880), or number of days over which opioid medication was taken (p=0.364), between the two cohorts. Subjective pain experience was the same on day of surgery (DOS) for the two graft choices (score: 2.4). Average pain scores increased by the same amount on post-operative day 1 (score: 2.7) for both groups, likely as residual effects from regional anesthetic wore off. By post-operative day 3, average pain scores in the ACLR-Q group (score: 2.3) and ACLR-HS group (score: 2.0) had declined to less than that seen on DOS, without statistical difference (p=0.350) in the pain level between the cohorts. Conclusion/Significance: Despite longer tourniquet and operative times in the ACLR-Q group, which is likely reflective of graft harvest/preparation time and a surgical learning curve associated with a relatively newer technique, adolescents and young adults who received quadriceps and hamstring tendon grafts had a similar profile of subjective pain and use of post-operative opioid medication in the immediate post-operative period. Differing rates of concomitant meniscal injury and regional anesthetic techniques may represent confounding factors that warrant future studies controlling for such factors. Importantly, both reconstructive techniques resulted in a large surplus of unused opioid medication, furthering the notion that evidence-based prescription practices for post-operative care in different surgical techniques is warranted by orthopaedic surgeons and sports medicine physicians to help stem the rising tide of the opioid epidemic.

Role of pre-operative serum magnesium (Mg) concentration on post-operative pain intensity and opioid usage in gynecologic surgery.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20673-e20673
Author(s):  
Laleh Azari ◽  
Sundae Stelts ◽  
Joseph T Santoso ◽  
Mehmet Kocak
Keyword(s):  
Pain Intensity ◽  
Serum Magnesium ◽  
Rank Correlation ◽  
University Hospital ◽  
Gynecologic Surgery ◽  
Opioid Use ◽  
Spearman’S Rank Correlation ◽  
Pain Scores ◽  
Post Operative Pain

e20673 Background: Hypomagnesemia is a common problem, occurring in nearly 12% of hospitalized patients. Due to the link of hypomagnesemia with surgery and the potential antinociceptive effects of Mg multiple trials have been conducted. Unfortunately, the role of IV and epidural Mg supplementation in pain management perioperatively remains controversial. An unanswered question from the literature to date is whether low serum Mg concentrations correlate with pain intensity. This review of patients undergoing gynecological surgeries examines whether pre-operative serum Mg level can affect pain scores and opioid use postoperatively. Methods: This was a retrospective study of the electronic medical record at Methodist University Hospital from October 1st, 2011 to July 31st, 2012. Included for analysis are all cases that underwent a gynecologic surgery and were performed under one attending surgeon. Each patient included in the study had perioperative serum Mg levels, resting and moving pain intensity scores, and amount of opioids used. Patients were excluded for any of the following criteria: missing data, discharge in less than 24 hours, robotic surgery, and use of ketamine in anesthesia. Statistical analysis included descriptive statistics, Spearman’s rank correlation coefficient, and logistic regression. Results: The analysis included 121 patients; 54% were Caucasian, the mean age was 51.7 years and 89% of surgeries were for oncologic indications. Pre-operative serum Mg level was not significantly associated with resting or moving pain intensity scores on post operative day (POD) 1 (p=0.66; p=0.68) or POD 2 (p=0.58, p=0.83). Pre-operative Mg level was not significantly associated with opioid use on POD 1 or 2. Two variables had a possible correlation with opioid usage, on average older patients used a lower level of opioid on average and patients with higher BMI used a higher level of opioids. Conclusions: Preoperative magnesium level has no correlation with pain scores or opioid use. While repletion maybe warranted and magnesium supplementation has minimal toxicity and cost, effect on post-operative pain is uncertain. Larger randomized trials may be warranted.

scholarly journals Characterizing the Effect of Opioid Tablet Strength on Post-Operative Opioid Consumption Following ACL Reconstruction

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0050
Author(s):  
Ehab Nazzal
Keyword(s):  
Acl Reconstruction ◽  
Pain Control ◽  
The United States ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Lower Strength ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Tablet Strength ◽  
Management Protocol

Objectives: Prescription opioid abuse continues to be a national crisis in the United States. Orthopaedic surgeons contribute significantly to this crisis, prescribing nearly a tenth of annual opioid prescriptions. With Anterior Cruciate Ligament (ACL) reconstruction being a common orthopaedic procedure performed at high volumes, understanding how physician opioid prescribing practices affects patient post-operative opioid utilization is of critical importance to curbing the orthopaedic contribution to the opioid epidemic. We aimed to assess how opioid tablet strength affects post-operative opioid consumption following ACL reconstruction. We hypothesized that prescribing a lower strength opioid tablet would not adversely influence post-operative pain or increase opioid consumption Methods: All data was collected prospectively from patients undergoing ACL reconstruction at a single academic ambulatory surgery center.All patients received the same peri-operative pain management protocol, which consisted of an adductor canal block at the time of surgery, Naprosyn 500 mg to be taken as needed, and pre-operative opioid education that outlined safe opioid use practice. Percocet was prescribed at two dosages in a consecutive fashion. Between March 2018 to October 2018, patients received Percocet at a strength of 7.5 mg (7.5 mg Oxycodone/325 Acetaminophen). From November 2018 to May 2019, patients received prescriptions at a dose of 5 mg. At the first post-operative clinic visit, patients completed a survey describing the quantity of opioid tablets consumed, days of postoperative opioid use, and opioid-related adverse effects. In addition, patients used a smart-phone application to assess post-operative pain on a numeric rating scale from post-operative day (POD) 1 to POD 6. Results: 148 patients were prospectively enrolled. 78 (51.3%) received Percocet at a strength of 7.5 mg per tablet and 69 (46.9%)received Percocet at a strength of 5 mg. The median age was 23 years (interquartile range: 18-36) and 49.7% were female. The 7.5 mg cohort took an average of 12.4 tablets (±7.0), while the 5 mg cohort took an average of 8.6 (±7.4) tablets, a 3.7 tablet decrease (p=0.002). Both cohorts consumed opioids for the same amount of post-operative days (5mg cohort: 3.1 days, 7.5mg cohort: 3.5 days; p=0.289). The incidence of opioid related side effect were equivalent between the 5 mg and 7.5 mg cohorts, which included constipation (34.8% and 34.6%, p=0.983), euphoria (5.8% v. 10.3%, p=0.324), nausea/vomiting (13.0% v. 16.7%, p=0.539), fatigue (2.9% v. 6.4%, p0.319), and pruritus (2.9% v. 5.1%, p=0.495). There was no difference in post-operative numeric pain scores in the 5 mg vs. the 7.5 mg cohort (POD 1: 5.7 ±1.9 vs. 5.4 ± 2.0, p=0.633; POD 6: 3.3 ± 2.1 vs. 2.9 ± 1.8, p=0.726). Conclusion: Prescribing a lower strength of oxycodone after ACL reconstruction did not increase pain scores or opioid consumption.This suggests that it is possible to achieve similar pain control while lowering the total opioid prescribed. These finding support future research focusing on optimizing pain control at minimal opioid doses.

scholarly journals Surgeon-Administered Nerve Block During Rotator Cuff Repair Can Promote Recovery with Little or No Post-operative Opioid Use

2020 ◽  
Vol 16 (S2) ◽  
pp. 349-357
Author(s):  
George L. Caldwell ◽  
Michael A. Selepec
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Inverse Correlation ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Nerve Blockade ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Management Protocol ◽  
Cuff Repair

Abstract Background The use of opioid analgesia is common in both the acute and extended post-operative periods after rotator cuff repair. The current opioid crisis has prompted surgeons to seek alternatives that minimize or even eliminate the need for oral opioids after surgery. Questions/Purposes We sought to investigate the effects on post-operative opioid use of a surgeon-administered block of the suprascapular and axillary nerves in arthroscopic rotator cuff repair (ARCR), in particular to quantify outpatient opioid consumption and duration. Methods In this prospective observational study, all patients undergoing primary ARCR performed under general anesthesia by a single surgeon were studied over a 15-month period. Of 91 ARCRs performed, 87 patients were enrolled and followed prospectively. At the conclusion of the procedure, the surgeon performed “local–regional” nerve blockade with injections to the sensory branches of the suprascapular nerve and the axillary nerve, as well as local infiltration about the shoulder. Use of medications in the post-anesthesia care unit was left up to the anesthesiologist. Patients were prescribed oral opioids (hydrocodone/acetaminophen 5/325 mg) for analgesia after discharge. The quantity and duration of opioid use and pain scores were recorded for 4 months. Statistical analysis was performed to evaluate factors that could account for greater opioid use. Results Total opioid consumption ranged from 0 to 30 opioid tablets (average, 4.2 tablets) over the 4-month period. Post-operatively, 91% of patients took between ten or fewer tablets, and 39% took no opioids. The average duration of opioid use was 2.4 days. No patients were taking opioids at the 4- to 6-week or 4-month follow-up visits, none required refills, and none received prescriptions from outside prescribers. No statistically significant differences were seen in opioids taken or duration of use in regard to tear size, sex, body mass index, surgery location, or procedure time. There was a significant inverse correlation between opioid use and age. In addition, the cost of the surgeon-performed procedure was substantially lower than that associated with pre-operative nerve blockade performed by an anesthesiologist. All patients were satisfied with the post-operative pain management protocol. Average reported post-operative pain scores were low and decreased at each visit. Conclusion With this local–regional nerve-blocking protocol, opioid use after ARCR was unexpectedly low, and a large proportion of patients recovered without any post-surgical opioids. The correlation seen between opioid use and age may not be clinically significant, given the low use of post-operative opioids overall. These results may be useful in guiding post-operative opioid prescribing after ARCR, as well as in lowering costs associated with ARCR.

scholarly journals Perioperative Continuation of Buprenorphine at Low–Moderate Doses Was Associated with Lower Postoperative Pain Scores and Decreased Outpatient Opioid Dispensing Compared with Buprenorphine Discontinuation

Pain Medicine ◽  
2020 ◽  
Vol 21 (9) ◽  
pp. 1955-1960 ◽  
Author(s):  
Aurora Quaye ◽  
Kevin Potter ◽  
Sarah Roth ◽  
Gregory Acampora ◽  
Jianren Mao ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Opioid Use Disorder ◽  
Postanesthesia Care Unit ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Medication Assisted Treatment ◽  
Pain Scores ◽  
Surgical Subspecialty ◽  
Number Of Individuals ◽  
Buprenorphine Treatment

Abstract Objective An increasing number of individuals are prescribed buprenorphine as medication-assisted treatment for opioid use disorder. Our institution developed guidelines for perioperative buprenorphine continuation with an algorithm for dose reduction based upon the surgical procedure and patient's maintenance dose. The objective of this study was to compare the effects of buprenorphine continuation with those of discontinuation on postoperative pain scores and outpatient opioid dispensing. Design Retrospective observational study. Subjects Surgical patients on buprenorphine from March 2018 to October 2018. Patients on buprenorphine for chronic pain and those with minor procedures were excluded from analysis. Methods We compared postoperative outpatient opioid dispensing and postanesthesia care unit (PACU) pain scores in patients where buprenorphine was continued compared with held perioperatively, collecting single surgical subspecialty prescriber data on outpatient full mu-opioid agonist prescriptions dispensed, converted into mean morphine equivalents. Buprenorphine formulations were not included in our morphine milligram equivalents (MME) total. Results There were 55 patients total (38 cont. vs 17 held). There was no difference in postoperative buprenorphine treatment adherence (91% cont. vs 88% held, P = 0.324). The number of opioid prescriptions dispensed was significantly higher with buprenorphine discontinuation (53% cont. vs 82% held, P = 0.011), as was MME dispensed (mean of 229 cont. vs mean of 521 held, P = 0.033). PACU pain scores were higher with buprenorphine discontinuation (mean 2.9 cont. vs mean 7.6 held, P &lt; 0.001). Conclusions There was a significant reduction in opioid prescriptions filled, MME dispensed, and PACU pain scores in patients where buprenorphine was continued vs held perioperatively. We provide evidence to support that buprenorphine can be continued perioperatively and that continuation is associated with decreased postoperative pain and decreased outpatient opioid dispensing. These results contribute to the existing literature supporting the perioperative continuation of buprenorphine.

scholarly journals Utilization of Over the Counter Analgesics Post-Operatively in Foot and Ankle Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0024
Author(s):  
Shamis Khan ◽  
Kenrick Lam ◽  
Joshua Acebo ◽  
Rishabh Jain ◽  
Vinod Panchbhavi
Keyword(s):  
Pain Control ◽  
Pain Tolerance ◽  
Foot And Ankle ◽  
Inclusion Criteria ◽  
Opioid Use ◽  
Over The Counter ◽  
Knowing That ◽  
Post Operative Pain ◽  
Lower Pain ◽  
Morphine Equivalent

Category: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics, Bunion, Hindfoot, Lesser Toes, Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Managing post-operative pain in patients has become a growing concern given the increasing focus on controlling opioid use. Over the counter (OTC) analgesics such as tylenol and ibuprofen have been shown to be useful adjuncts to post-operative pain regimens and may decrease opioid use. However utilization of these adjuncts may be limited by patient education especially if they are not formally prescribed by the physcian. In this work we aim to identify how often post-operative patients utilize OTC analgesics to supplement their pain control and what are the barriers to usage. Methods: All bony foot and ankle procedures performed by a single foot and ankle surgeon were reviewed between the dates of 7/1/2017 - 6/30/2018. Inclusion criteria were age over 18 and not incarcerated. Bony procedures included any osteotomy, fracture fixation, or arthrodesis. This subset of patients were then called and surveyed about their post-operative pain. 114 patients met inclusion criteria. Results: 42 patients responded to the survey. 27 (64%) of patients did not supplement their pain control with OTC analgesics. The most common reason why (13/27 patients) OTC meds were not used was because pain control on narcotics alone was sufficient. Other reasons included dislike of polypharmacy, not believing they would be efficacious, and not knowing that it is was safe to take them. Total narcotic use between the two groups was higher in the OTC group however (760 mg morphine equivalent in the no OTC group and 1073 mg morphine equivalent in the OTC group, p = 0.25). Conclusion: This study highlights the misconception of patients in regards to optimal pain control. The higher absolute narcotic usage in the OTC group may reflect that patients who feel the need to supplement their pain regimen have lower pain tolerance to begin with.

Interest in long-acting injectable buprenorphine among syringe services program participants

2021 ◽  
Vol 17 (7) ◽  
pp. 59-67
Author(s):  
Hannah Epstein, BS ◽  
Andres Perez-Correa, MD ◽  
Jason Beltre, BS ◽  
Christine Fitzsimmons, ASN ◽  
Pia Marcus, BA ◽  
...  
Keyword(s):  
Outcome Measure ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Sublingual Buprenorphine ◽  
Item Questionnaire ◽  
Treatment Models ◽  
Median Level ◽  
Monthly Injection ◽  
Long Acting ◽  
Buprenorphine Treatment

Objective: To examine syringe services program (SSP) participants’ interest in long-acting injectable buprenorphine.Design: SSP participants completed a 136-item questionnaire by phone. Items assessed quantitative ratings of interest in sublingual and injectable buprenorphine, preference for sublingual versus injectable buprenorphine, and reasons for preferences.Setting: Two large urban SSPs.Participants: SSP participants ≥18 years of age with current or lifetime opioid use disorder (OUD).Main outcome measure(s): (1) Interest in sublingual and injectable buprenorphine, respectively, on a scale from 0 to 10 (0 = no interest and 10 = high interest); and (2) preference for sublingual buprenorphine versus injectable buprenorphine. Participants were also asked whether they agreed with statements that presented potential reasons for preferring each formulation.Results: A total of 104 unique participants were interviewed, of which 72 (69 percent) were currently receiving or considering buprenorphine treatment. Among these 72 participants, the median level of interest in starting or continuing sublingual buprenorphine was 8 out of 10 (interquartile range [IQR]: 6-10) and in starting injectable buprenorphine was 5 out of 10 (IQR: 1-9). Thirty-six (50 percent) preferred sublingual, 27 (38 percent) preferred injectable, and 9 (13 percent) preferred neither or declined to answer. Participants who preferred injectable buprenorphine most commonly agreed that the convenience of the monthly injection was the reason for their preference.Conclusions: Among SSP participants with OUD, we found moderate interest in injectable buprenorphine. Introducing this new form of buprenorphine treatment at SSPs could help meet the needs of individuals who are not well-served by standard OUD treatment models.

scholarly journals OPIOID USE IN ADOLESCENTS FOLLOWING HIP AND KNEE ARTHROSCOPY

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0008
Author(s):  
S. Clifton Willimon ◽  
Michael Busch ◽  
Melissa Christino ◽  
Belinda Schaafsma ◽  
Crystal Perkins
Keyword(s):  
Risk Factors ◽  
Pain Control ◽  
Knee Arthroscopy ◽  
Medication Use ◽  
Pain Medication ◽  
Opioid Use ◽  
Pain Scores ◽  
Pain Medications ◽  
Post Operative Pain ◽  
Opioid Medications

Background: The use and misuse of opioid medications has been declared an epidemic and public health emergency by the Centers for Disease Control. From 1999 – 2016, there was a 5-fold increase in overdose deaths secondary to opioids1. Pain control is an important component of post-operative care following orthopaedic surgery and opioid medications are commonly prescribed. The purpose of this study is to describe the average opioid use among adolescents following hip and knee arthroscopy. Methods: All patients less than 21 years of age undergoing ACL reconstruction, simple knee arthroscopy (plica and fat pad debridement, loose body removal, partial meniscectomy, or chondroplasty), and hip arthroscopy for femoroacetabular impingement were prospectively enrolled in this IRB-approved study. This is an interim report for an ongoing study with anticipated completion of enrollment in December 2018. All patients received hydrocodone-acetaminophen 5-325 mg for post-operative pain control. The number of pills prescribed was based on physician preference and was not dictated by the study. Patients and their families completed a medication logbook to track all doses of pain medication and associated pain scores. Risk factors for hydrocodone use following surgery were analyzed, including age, sex, race, pre-operative use of narcotic pain medications, surgical factors, and post-operative VAS pain scores. Results: A total of 65 patients were enrolled and completed the medication logbook, including 37 females and 28 males with a mean age of 15.6 years (range 7 – 20 years). Patients received a prescription for an average of 28 hydrocodone tablets (range 10 – 60) and 64 patients (98%) filled the prescription. The mean number and range of hydrocodone tablets consumed and remaining at the end of treatment and VAS pain scores at the time the patients consumed the pain medication are listed in the figure below. Forty-two patients (65%) reported one or more side effects from the hydrocodone, with the most common being drowsiness and constipation. There were no risk factors that predicted increased use of hydrocodone following ACL reconstruction or knee arthroscopy. Female sex and higher post-operative VAS pain scores predicted greater use of hydrocodone in patients following hip arthroscopy. Conclusions: Opioid medication use in adolescents following hip and knee arthroscopy is significantly less than the quantity of tablets prescribed, with 60% of the medication we prescribed remaining unused in the post-operative period. We recommend orthopaedic surgeons responsibly prescribe pain medications using evidence-based data or the results of their own experience monitoring medication consumption. Additionally, and important in the setting of the “opioid epidemic,” physicians must counsel patients and families of post-operative pain expectations and appropriate medication use. This study will provide the framework for the future development of educational resources regarding prescribing and use of pain medications for healthcare providers, patients, and caregivers. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2017 [Table: see text]

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