Research Day

Title

OPIOID CONSUMPTION AFTER ELECTIVE SHOULDER ARTHROSCOPY SURGERY

Document Type

Abstract

Date

2018

Abstract

BACKGROUND/INTRODUCTION: Opioid pain medications are commonly prescribed for post-operative pain control. Historically there has been an emphasis to control pain in our patients; however, more recently this has led to an increase in opioid usage.123 This increased usage may be a reason for more widespread opioid prescription resulting in a concern for abuse and addiction.4 Previous studies have examined the use of opioids after upper extremity surgery 567. Although there are published studies on opioid prescriptions and upper extremity surgery, there is a paucity of literature discussing pain medication after shoulder arthroscopy.

OBJECTIVE/PURPOSE/RATIONALE: The purpose of our study is to quantify the average amount of opioid pain medication consumed by patients after shoulder arthroscopy surgery. Our hypothesis is that patients will consume less pain medications than they are prescribed. This information can then guide orthopedic surgeons as to an appropriate number of pain pills to provide to adequately control pain.

MATERIALS AND METHODS: This study was approved by our IRB committee. Patients scheduled to undergo elective shoulder arthroscopy were invited to participate in this study at their pre-op appointment. Inclusion criteria will include patients >18 years old, ability to give informed consent, and patients undergoing elective shoulder arthroscopy. Exclusion criteria will include patients <18 years old, inability to give informed consent, non-elective shoulder arthroscopy surgeries, any instance where there was a concurrent open procedure in addition to the arthroscopy, and all revision surgeries. All patients underwent elective shoulder arthroscopy in the beach chair position. All patients were given an interscalene block single shot. Patients were given a prescription for 50 tablets of Norco (5mg/325mg) or Percocet (5mg/325mg). Patients were asked to complete a postoperative log form documenting their pain VAS score, number of tablets taken, time, and date. Also recorded was the time and date postoperatively their interscalene block was complete. The form was collected at their two week follow-up appointment. SAS v9.4 was used to perform the statistical analyses.

RESULTS: 16 patients’ completed the study and had data available to analyze at the time of abstract submission. The average total number of opioid pills consumed by the patient’s was 16.56. The average total morphine equivalents consumed by the patient’s was 19.54. The average percentage of pills consumed out of what was prescribed was 31.93%.

CONCLUSION: After shoulder arthroscopy patients in our study consumed on average only a third of the opioid pain medication they were prescribed. This was on average around 17 pills. The average percentage of opioids consumed by patients in this study from what was prescribed is similar to that in other studies. We believe that prescribing less opioids after shoulder arthroscopy will allow for adequate pain control along with minimizing the risk for abuse and addiction to opioid medications. This data also gives surgeons performing elective shoulder arthroscopy a reference in opioid usage to help educate patients preoperatively, which can improve patient expectations and outcomes.

REFERENCE:

1. Kuehn BM. Opioid Prescriptions Soar. JAMA. 2007;297(3):249. doi:10.1001/jama.297.3.249.

2. Okie S. A Flood of Opioids, a Rising Tide of Deaths. N Engl J Med. 2010;363(21):1981-1985. doi:10.1056/NEJMp1011512.

3. Frenk SM, Porter KS, Paulozzi LJ. Prescription opioid analgesic use among adults: United States, 1999-2012. NCHS Data Brief. 2015;(189):1-8. http://www.ncbi.nlm.nih.gov/pubmed/25714043. Accessed November 15, 2016.

4. Florence CS, Zhou C, Luo F, Xu L. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Med Care. 2016;54(10):901-906. doi:10.1097/MLR.0000000000000625.

5. Rodgers J, Cunningham K, Fitzgerald K, Finnerty E. Opioid Consumption Following Outpatient Upper Extremity Surgery. J Hand Surg Am. 2012;37(4):645-650. doi:10.1016/j.jhsa.2012.01.035.

6. Waljee JF, Zhong L, Hou H, Sears E, Brummett C, Chung KC. The Use of Opioid Analgesics following Common Upper Extremity Surgical Procedures. Plast Reconstr Surg. 2016;137(2):355e-364e. doi:10.1097/01.prs.0000475788.52446.7b.

7. Stanek JJ, Renslow MA, Kalliainen LK. The Effect of an Educational Program on Opioid Prescription Patterns in Hand Surgery: A Quality Improvement Program. J Hand Surg Am. 2015;40(2):341-346. doi:10.1016/j.jhsa.2014.10.054.

This document is currently not available here.

Share

COinS