Today’s article, “Multimodal Nonopioid Pain Protocol Provides Equivalent Pain Versus Opioid Control Following Meniscus Surgery: A Prospective Randomized Controlled Trial” is from Jildeh et al.
This article touches on an important subject of attempting to eliminate post-operative opioid medications. The opioid crisis is well known but we continue to learn how to optimally manage pain after surgery.
The main outcome was pain after meniscus surgery, mainly menisectomy. Their protocol included the following pre-operative medications given to both groups: gabapentin 300 mg, tramadol 50 mg, acetaminophen 975 mg, and celecoxib 400 mg, 8mg dexamethasone IV. They also performed an intraoperative infiltration local anesthetic and ketorolac at the incision sites. The opioid group was prescribed hydrocodone/APAP 5mg/325mg 1-2 every 4-6 hours as needed for moderate to severe pain. The non-opioid group were given Tylenol 1,000 mg three times a day, Gabapentin 300mg three times a day, diazepam 5 mg four times a day, and ketorolac four times a day for the first five days. For the next 5 days patients were given meloxicam twice a day, Tylenol three times a day, and diazepam three times a day.
The study ultimately showed that patients reported no significant difference in self-reported pain scores over the first 10 days after surgery between the groups. They also did not show a difference in adverse effects between the two groups. The most common adverse effects in the two groups were constipation and drowsiness. While opioids are known to cause constipation, the authors mention the constipation in the non-opioid group is likely from the gabapentin and diazepam which also cause constipation.
Of note, each group did include one patient that underwent a meniscal repair rather than menisectomy. As meniscus repairs may require more pain medicine it would be hard to draw conclusions from this small sample size.
This was an interesting study and I look forward to more like it that will help us reduce the opioid burden.
