New research presented at the American Academy of Orthopaedic Surgeons (AAOS) 2019 Annual Meetingreports on the results of a major undertaking by the Department of Orthopedic Surgery at NYU Langone Health to curb opioid prescriptions and usage rates following common orthopedic procedures.
Opioid abuse has tripled in recent years according to the AAOS, and orthopedic surgeons are the third-highest prescribers of these highly addictive medications. To address this ongoing crisis in orthopedics, NYU Langone Health’s department of orthopedic surgery led an institution-wide effort to rethink and reduce the use of opioids in patient care for subspecialty procedures, to make more common procedures opioid-free or opioid-light. Results of these efforts, coordinated across divisions of the Department of Orthopedic Surgery, are being presented at the AAOS 2019 Annual Meeting, March 12-16, in Las Vegas, Nevada, and may be applicable to other orthopedic programs across the country, according to the authors.
“NYU Langone orthopedic surgeons have collaborated closely with other hospital stakeholders, including anesthesia, pain management, pharmacy and healthcare IT, to develop a cross-functional response to the opioid epidemic,” says Joseph A. Bosco, MD, professor of orthopedic surgery and vice chair of clinical affairs at NYU Langone, and second vice president of the American Academy of Orthopaedic Surgeons.
“Our results reflect that all of us in orthopedic surgery need to look at our surgeries, reexamine our protocols, and work across our institutions to minimize opioid use while still maximizing patient comfort and recovery,” says Joseph D. Zuckerman, MD, chair and the Walter A.L. Thompson Professor of Orthopedic Surgery at NYU Langone.
Randomized Trial Reports Opioid Reductions for Arthroscopic Shoulder Instability Repairs
Sports Medicine orthopedic surgeons at NYU Langone, led by Kirk A. Campbell MD, assistant professor of orthopedic surgery, enrolled 80 patients, average age of 33 years, between December 2017 and May 2018, who were set to undergo arthroscopic shoulder instability repair. Forty were randomized to receive Ibuprofen 600mg and a 10-pill rescue prescription of oxycodone 5mg, and 40 received only a prescription of 30 tabs of oxycodone 5mg. The number of opioids patients used were recorded on days 1, 4, and 7 after surgery, and patients were administered a visual analog scale (VAS) test to measure their pain intensity.
Dr. Campbell and colleagues reported that the total amount of opioid consumption was significantly lower in the group given Ibuprofen with a rescue opioid prescription, compared to the opioid-alone group (6.9 vs 10.1, p<0.04). There were no significant differences in pain intensity scores at any time point after surgery between the two groups.
“As both groups of patients showed similar pain levels post-operatively, we feel it is possible to alleviate postoperative pain with lower amounts of opioids than what are typically being prescribed. Our research also shows adding NSAID medications to the regimen may too decrease opioid use.” says Dr. Campbell.