Opioid Consumption Following Anterior Cruciate Ligament Reconstruction: A Systematic Review

Area of Science:

• Orthopedic Surgery
• Pain Management
• Pharmacology

Background:

• Guidelines for oral opioid prescriptions following anterior cruciate ligament reconstruction (ACLR) are currently lacking.
• There is a need for data-driven recommendations to manage postoperative pain and opioid consumption.

Purpose of the Study:

• To conduct a systematic review of existing literature.
• To quantify oral opioid pill consumption in patients after ACLR.

Main Methods:

• Systematic literature search using PRISMA guidelines across multiple databases (MEDLINE, Embase, Scopus, Cochrane CENTRAL).
• Included studies quantified postoperative opioid consumption for at least 4 days.
• Extracted data included initial prescription size, pill type, and additional prescriptions.

Main Results:

• Twenty articles were included, analyzing oral opioid consumption post-ACLR.
• Opioid consumption varied widely, ranging from 2.3 to 32.2 tablets of 5-mg oxycodone (17.3-242 MMEs).
• Effective strategies to decrease opioid use included preoperative nerve blocks, local anesthetic injections (e.g., bupivacaine), and multimodal analgesia.

Conclusions:

• Preoperative and postoperative interventions can significantly reduce opioid consumption after ACLR.
• While specific nonopioid analgesics' optimal use requires further study, multimodal approaches show promise.
• This review establishes a foundation for future research on nonopioid pain management strategies post-ACLR.