Lower Opioid Prescription Quantity Does Not Negatively Impact Pain Control or Patient Satisfaction After ACL Reconstruction: A Randomized, Prospective Trial

• Published in: Journal of bone and joint surgery. American volume 2024-03, Vol.106 (5), p.435-444
• Main Authors: Johns, William L, Hanna, Adeeb Jacob, Destine, Henson, Sonnier, John Hayden, Dodson, Christopher, Tucker, Bradford, Pepe, Matthew, Freedman, Kevin B, Tjoumakaris, Fotios
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - therapeutic use; Humans; Pain, Postoperative - drug therapy; Patient Satisfaction; Prescriptions; Prospective Studies
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.23.00657

The purpose of this study was to evaluate the effects of different quantities of prescribed opioid tablets on patient opioid utilization, postoperative pain and function, and satisfaction after anterior cruciate ligament reconstruction (ACLR). This was a prospective, randomized trial enrolling patients undergoing primary ACLR. Patients were assigned to 1 of 3 prescription groups: 15, 25, or 35 tablets containing 5-mg oxycodone. Patients completed visual analog scale (VAS) pain and medication logs, opioid medication satisfaction surveys, and International Knee Documentation Committee (IKDC) questionnaires postoperatively. Among the 180 patients included in the analysis, there was no significant difference in VAS pain scores (p > 0.05), IKDC scores (p > 0.05), morphine milligram equivalents (MMEs) (p = 0.510) consumed, or patient satisfaction with regard to pain control (p = 0.376) between treatment groups. Seventy-two percent of opioids were consumed in the first 3 days postoperatively, and 83% of patients in the 15-tablet cohort felt that they received the "right amount" of or even "too many" opioids. The prescription of 15 opioid tablets resulted in equivalent pain control, patient satisfaction, and short-term functional outcomes as prescriptions of 25 or 35 opioid tablets after ACLR. Lower prescription quantities of opioid medication may provide equivalent postoperative pain and help to minimize the number of unused opioid doses at risk for possible diversion after ACLR. Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.