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Patients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess

PURPOSE: To generate an evidence-based opioid-prescribing guideline by assessing the pattern of total opioid consumption and the factors that may predict opioid consumption following arthroscopic release of elbow contracture and to investigate whether the use of continuous passive motion (CPM), as c...

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Autores principales: Rojas Lievano, Jorge, Rotman, Dani, Shields, Maegan N., Morrey, Mark E., Sanchez-Sotelo, Joaquin, Shukla, Dave R., Olson, Tammy S., Vaichinger, Anthony M., Fitzsimmons, James S., O’Driscoll, Shawn W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689263/
https://www.ncbi.nlm.nih.gov/pubmed/34977643
http://dx.doi.org/10.1016/j.asmr.2021.09.002
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author Rojas Lievano, Jorge
Rotman, Dani
Shields, Maegan N.
Morrey, Mark E.
Sanchez-Sotelo, Joaquin
Shukla, Dave R.
Olson, Tammy S.
Vaichinger, Anthony M.
Fitzsimmons, James S.
O’Driscoll, Shawn W.
author_facet Rojas Lievano, Jorge
Rotman, Dani
Shields, Maegan N.
Morrey, Mark E.
Sanchez-Sotelo, Joaquin
Shukla, Dave R.
Olson, Tammy S.
Vaichinger, Anthony M.
Fitzsimmons, James S.
O’Driscoll, Shawn W.
author_sort Rojas Lievano, Jorge
collection PubMed
description PURPOSE: To generate an evidence-based opioid-prescribing guideline by assessing the pattern of total opioid consumption and the factors that may predict opioid consumption following arthroscopic release of elbow contracture and to investigate whether the use of continuous passive motion (CPM), as compared to physical therapy (PT), was associated with a decrease in pain and opioid consumption after arthroscopic release of elbow contracture. METHODS: Data collected from a randomized controlled trial that compared continuous passive motion (CPM) (n = 24) to physical therapy (PT) (n = 27) following arthroscopic release of elbow contracture was analyzed for opioid use. Fifty-one participants recorded their daily opioid consumption in a postoperative diary for 90 days. Multivariate analysis was performed to identify factors associated with opioid use. Recommended quantities for postoperative prescription were generated using the 50th percentile for patients without and the 75th percentile for patients with factors associated with higher opioid use. RESULTS: The median total opioid prescription was 437.5-mg morphine milligram equivalents (MMEs) (58 pills of 5 mg oxycodone) and the median total opioid consumption was 75 MMEs (10 pills of 5-mg oxycodone). Twenty-two percent of patients took no opioid medication, 53% took ≤10 pills, 69% took ≤20 pills and 75% took ≤30 pills. Predictors of higher opioid use were preoperative opioid use, age <60 years and inflammatory arthritis. The total opioid consumption appeared similar between the CPM and the PT group. Seventy-five percent of patient’s home opioid requirements would be satisfied using the following guideline: Patients undergoing contracture release for osteoarthritis or post-traumatic contracture should be given a prescription for 10 pills of 5 mg oxycodone or its equivalent at discharge. Patients with inflammatory conditions or those taking preoperative opioids should be prescribed 30 pills of 5 mg oxycodone or its equivalent. CONCLUSION: This study suggests that most patients undergoing arthroscopic release of elbow contracture use relatively few opioid pills after surgery. Use of an evidence-based guideline could decrease opioid prescriptions substantially, while still effectively treating patients’ pain.
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spelling pubmed-86892632021-12-30 Patients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess Rojas Lievano, Jorge Rotman, Dani Shields, Maegan N. Morrey, Mark E. Sanchez-Sotelo, Joaquin Shukla, Dave R. Olson, Tammy S. Vaichinger, Anthony M. Fitzsimmons, James S. O’Driscoll, Shawn W. Arthrosc Sports Med Rehabil Original Article PURPOSE: To generate an evidence-based opioid-prescribing guideline by assessing the pattern of total opioid consumption and the factors that may predict opioid consumption following arthroscopic release of elbow contracture and to investigate whether the use of continuous passive motion (CPM), as compared to physical therapy (PT), was associated with a decrease in pain and opioid consumption after arthroscopic release of elbow contracture. METHODS: Data collected from a randomized controlled trial that compared continuous passive motion (CPM) (n = 24) to physical therapy (PT) (n = 27) following arthroscopic release of elbow contracture was analyzed for opioid use. Fifty-one participants recorded their daily opioid consumption in a postoperative diary for 90 days. Multivariate analysis was performed to identify factors associated with opioid use. Recommended quantities for postoperative prescription were generated using the 50th percentile for patients without and the 75th percentile for patients with factors associated with higher opioid use. RESULTS: The median total opioid prescription was 437.5-mg morphine milligram equivalents (MMEs) (58 pills of 5 mg oxycodone) and the median total opioid consumption was 75 MMEs (10 pills of 5-mg oxycodone). Twenty-two percent of patients took no opioid medication, 53% took ≤10 pills, 69% took ≤20 pills and 75% took ≤30 pills. Predictors of higher opioid use were preoperative opioid use, age <60 years and inflammatory arthritis. The total opioid consumption appeared similar between the CPM and the PT group. Seventy-five percent of patient’s home opioid requirements would be satisfied using the following guideline: Patients undergoing contracture release for osteoarthritis or post-traumatic contracture should be given a prescription for 10 pills of 5 mg oxycodone or its equivalent at discharge. Patients with inflammatory conditions or those taking preoperative opioids should be prescribed 30 pills of 5 mg oxycodone or its equivalent. CONCLUSION: This study suggests that most patients undergoing arthroscopic release of elbow contracture use relatively few opioid pills after surgery. Use of an evidence-based guideline could decrease opioid prescriptions substantially, while still effectively treating patients’ pain. Elsevier 2021-11-17 /pmc/articles/PMC8689263/ /pubmed/34977643 http://dx.doi.org/10.1016/j.asmr.2021.09.002 Text en © 2021 Mayo Foundation for Medical Education and Research https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Original Article
Rojas Lievano, Jorge
Rotman, Dani
Shields, Maegan N.
Morrey, Mark E.
Sanchez-Sotelo, Joaquin
Shukla, Dave R.
Olson, Tammy S.
Vaichinger, Anthony M.
Fitzsimmons, James S.
O’Driscoll, Shawn W.
Patients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess
title Patients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess
title_full Patients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess
title_fullStr Patients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess
title_full_unstemmed Patients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess
title_short Patients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess
title_sort patients use fewer opioids than prescribed after arthroscopic release of elbow contracture: an evidence-based opioid prescribing guideline to reduce excess
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689263/
https://www.ncbi.nlm.nih.gov/pubmed/34977643
http://dx.doi.org/10.1016/j.asmr.2021.09.002
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