An Opioid-Free Perioperative Pain Protocol Is Noninferior to Opioid-Containing Management: A Randomized Controlled...

Area of Science:

• Orthopaedic Surgery
• Pain Management
• Multimodal Analgesia

Background:

• Orthopaedic surgeons increasingly use multimodal pain management to reduce opioid consumption.
• Complete elimination of perioperative opioids remains an under-explored area.
• This study investigates a novel opioid-free pathway against a standard opioid-containing regimen.

Purpose of the Study:

• To compare the efficacy and safety of an opioid-free pain management pathway versus an opioid-containing pathway.
• To evaluate pain control across five common orthopaedic subspecialty procedures.
• To assess patient-reported outcomes and safety profiles of both pathways.

Main Methods:

• A randomized, unblinded study with 315 patients (157 opioid-free, 158 opioid-containing).
• Pain assessed using a 0-10 numeric rating scale (NRS) at multiple time points (primary outcome at 24 hours).
• Collected data included patient characteristics, pathway adherence, morphine milligram equivalents (MME), readmissions, adverse events, and patient-reported outcomes.

Main Results:

• The opioid-free group demonstrated statistically noninferior pain control at 24 hours (median NRS 2 vs. 4, p < 0.0001).
• Significantly lower pain levels were observed in the opioid-free group at 12 hours and 2 weeks.
• Greater patient comfort at 24 hours and higher satisfaction with pain control at 6 weeks were reported in the opioid-free group, with no significant difference in adverse events or readmissions.

Conclusions:

• An opioid-free pain management pathway is safe and effective for common orthopaedic procedures.
• It provides noninferior pain control at 24 hours compared to opioid-containing pathways.
• This pathway enhances patient comfort and satisfaction, supporting its clinical implementation.