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Arthroscopy. 2018 Dec;34(12):3236-3243. doi: 10.1016/j.arthro.2018.07.021. Epub 2018 Nov 2.

Opioid Overprescription After Knee Arthroscopy and Related Surgery in Adolescents and Young Adults.

Author information

1
Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital, Boston, U.S.A.
2
Harvard Medical School, Boston, Massachusetts, U.S.A.; Harvard T.H. Chan School of Public Health, Boston, MA, U.S.A.
3
Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital, Boston, U.S.A.; Harvard Medical School, Boston, Massachusetts, U.S.A.; The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, U.S.A.
4
Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital, Boston, U.S.A.; Harvard Medical School, Boston, Massachusetts, U.S.A.; Harvard T.H. Chan School of Public Health, Boston, MA, U.S.A.. Electronic address: mininder.kocher@childrens.harvard.edu.

Abstract

PURPOSE:

The purpose of this study was to compare the number of opioids prescribed with the amount of pain medication required after knee arthroscopy and related surgery in adolescent and young adult patients to determine the effectiveness of current pain-control practices at a single institution. The secondary purpose was to determine what demographic or surgical factors are associated with increased opioid intake.

METHODS:

Adolescent and young adult patients who underwent knee arthroscopy and related surgery, including ligament reconstruction or tibial tubercle osteotomy, between May and August 2016 were provided pain-control logbooks in which they were asked to maintain a record of daily pain medication intake. The outcome of the study was defined as the total number of opioids consumed per patient.

RESULTS:

One hundred patients returned completed logbooks, 56% of whom were female patients. The average age was 17.54 years (standard deviation [SD], 3.51 years). Most patients underwent an open procedure concurrent with knee arthroscopy (60%), underwent nerve block placement (51%), and underwent injection of local anesthesia (91%). Use of both intravenous acetaminophen and ketorolac during the perioperative period was also common (41%). Patients were prescribed an average of 50.98 oxycodone pills (SD, 12.50 pills) and reported consuming an average of 16.52 pills (SD, 13.94 pills), approximately 32.4% of those prescribed. Eleven percent never consumed opioids, and only 1 patient requested a refill during the 21-day postoperative period. Multivariate analysis showed that increased weight, longer surgery time, and increased diazepam use were most closely associated with increased opioid consumption.

CONCLUSIONS:

After knee arthroscopy and related surgery, including ligament reconstruction or tibial tubercle osteotomy, adolescent and young adult patients are commonly overprescribed opioids, consuming on average only approximately one-third of those prescribed.

LEVEL OF EVIDENCE:

Level IV, case series.

PMID:
30396797
DOI:
10.1016/j.arthro.2018.07.021
[Indexed for MEDLINE]

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