Non-opioid pain management in younger patients undergoing arthroscopic glenoid labrum surgery: a randomized...

Opioids are traditionally prescribed for postoperative pain management following arthroscopic glenoid labrum repair in young patients. Injudicious use has contributed to rising rates of dependence and overdose, and subsequent interest in opioid-sparing strategies. This study compared the efficacy of multimodal non-opioid to opioid-containing regimens for postoperative pain control in young patients undergoing arthroscopic labral repair.

A single-center, prospective, randomized controlled trial was conducted from February 2023 to December 2025. Opioid-naive patients between 15 and 25 years of age undergoing an arthroscopic labrum repair were randomized into standard postoperative pain protocol group, prescribed 5 oxycodone 5 mg tablets, or the experimental non-opioid group. All patients received an interscalene nerve block. Demographics, comorbidities, daily morphine milligram equivalents (MMEs) consumed and visual analog scale (VAS) pain scores for 14 postoperative days, and pain control satisfaction were collected. Analysis was by intention to treat (ITT), representing randomization groups, and as treated, grouped by consumption or nonconsumption of opioids. A mixed model estimated differences in outcomes while accounting for variability to assess postoperative VAS and MME.

A total of 34 patients were included in this analysis (ITT: 17 experimental, 17 control) with mean age of 17.8 years (standard deviation 3.9), 24% female, 82% with labral tears secondary to sports injury, and mean number of anchors used of 4.1 (±1.7). Only 1 experimental patient requested oxycodone postoperatively. A total of 29 patients (85.29%) did not consume any postoperative opioids, including 16 (94.12%) in the experimental group and 13 (76.47%) in the control group. In ITT, mean total MME consumption was low in both groups (experimental 4.0 vs. control 2.4), with no significant differences in daily MME use, VAS pain scores, or satisfaction with pain control (P > .05). By day 14, 88.24% of patients reported being "very satisfied" with their pain management.

This study found no significant differences in postoperative opioid consumption, VAS pain scores, or patient satisfaction between opioid-containing and non-opioid regimens following arthroscopic labral repair. Overall opioid use was extremely low across both groups. These findings support the viability of non-opioid regimens in this patient population.