Preoperative opioid education has no effect on opioid use in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial

OBJECTIVES: Opioid analgesics are frequently utilized among orthopaedic surgeons to mitigate postoperative pain. These drugs are well-known for their addictive potential and recent literature has suggested that preoperative patient-focused education on narcotic consumption may decrease post-operative opioid use. The purpose of this study was to determine whether preoperative opioid education reduces consumption following arthroscopic rotator cuff (ARTC) repair in the context of our current environment of limiting post-operative narcotic consumption. METHODS: This is a single center randomized controlled trial. Opioid-naïve patients undergoing ARTC repair were randomized into one of two groups. Preoperatively, the control group received our institution’s standard of care for pain management education while the experimental group was shown a brief educational video on the proper use and dangers of opioids. All patients were discharged with 30 tabs of oxycodone-acetaminophen (5mg/325mg) prescribed as 1-2 tablets every 4-6 hours as needed for pain. They were contacted daily and asked to report opioid use, VAS pain, and satisfaction with overall pain management. A chart review was conducted at 3 months post-op to see if patients had been given narcotic refills after the initial postoperative period. RESULTS: Our institution enrolled 106 patients, 87 of whom completed the study (41 control, 46 experimental). There were no statistically significant differences (p>0.05) with respect to patient demographics between groups (age at time of surgery, gender, ASA, or BMI). Additionally, there was no statistically significant difference with respect to Visual Analogue Scale (VAS) pain between groups preoperatively (p=0.85) or at 1-week follow up (p=0.29). Additionally, patients in each group were equally satisfied with their post-operative pain medication management (p=0.71). Patients in the education group did not utilize a statistically significant different number of narcotics than the control group throughout the first post-operative week (14.74 pills experimental vs. 13.71 pills control, p=0.68). At 3-month follow up, patients in the experimental group (n=9) were equally likely to have utilized at least one narcotic prescription refill as the control group (n=5) (odds ratio 1.65, p=0.56). CONCLUSION: The findings of this study suggest that preoperative video-based opioid education may have no effect on reducing the number of narcotic pills consumed following ARTC repair. As such, this form of intervention may not be of use with respect to mitigating the current opioid crisis.