Postoperative Opioid Reduction Using a Multimodal Pain Protocol for Outpatient Orthopaedic Sports Medicine Surgery

Area of Science:

• Orthopaedic Surgery
• Pain Management
• Pharmacology

Background:

• Opioid medications are standard for postoperative pain in orthopaedic surgery.
• Multimodal pain management strategies can decrease opioid prescriptions in orthopaedic procedures.

Purpose of the Study:

• To assess the impact of a division-wide multimodal pain protocol on reducing opioid prescriptions and managing postoperative pain in orthopaedic sports medicine.
• To analyze opioid consumption and patient-reported pain levels following protocol implementation.

Main Methods:

• A retrospective cohort study compared pre- and post-protocol groups (n=40 each) for orthopaedic sports medicine procedures.
• Procedures were tiered based on pain levels, with a specific multimodal pain protocol applied to each tier.
• Outcomes measured included visual analog scale (VAS) pain scores at 2 weeks, opioid prescription quantities, and time to opioid discontinuation.

Main Results:

• Opioid prescriptions decreased by 43.6% post-protocol implementation (35.7 pills pre- vs. 20.1 pills post-protocol, P < .0001).
• No significant difference in VAS pain scores was observed at 2 weeks postoperatively (2.72 pre- vs. 2.99 post-protocol, P = .40).
• Continued opioid use at 2 weeks dropped significantly, with only 1 patient in the post-protocol group versus 20 in the pre-protocol group (P < .001).

Conclusions:

• Implementing a multimodal pain protocol in orthopaedic sports medicine effectively reduced opioid prescriptions without compromising 2-week postoperative pain control.
• Despite reduced prescriptions, 64.1% of prescribed opioids were consumed, suggesting potential for further optimization to prevent overprescription.