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Opioids Might Not Be Needed After Knee Surgery


By Alan Mozes
HealthDay Reporter

TUESDAY, Nov 23, 2021 (HealthDay Information) — Addictive opioid painkillers aren’t the one choice for sufferers looking for aid following anterior cruciate ligament (ACL) knee reconstruction, researchers say.

As the USA wrestles with skyrocketing charges of opioid abuse and drug overdose deaths, the findings might come as excellent news.

After ACL surgical procedure, Advil and different nonsteroidal anti-inflammatory medication (NSAIDs), acetaminophen (Tylenol) and muscle relaxers seem to supply the identical diploma of ache management to sufferers as prescription opioids like morphine, hydrocodone or oxycodone, the small research concluded.

“Opioid medicines will be useful in managing excessive ranges of ache when appropriately prescribed,” defined research co-author Dr. Kelechi Okoroha. He’s an orthopedic surgeon and sports activities harm specialist with the Mayo Clinic in Minneapolis.

“Nevertheless, when used for lengthy durations of time, opioids will be addicting,” Okoroha cautioned. And “when used incorrectly, or in excessive doses, opioids can have unwanted effects, together with drowsiness, confusion, slowed respiration and even demise.”

Drug overdose deaths in the USA are at an all-time excessive, the U.S. Facilities for Illness Management and Prevention reported this month — 100,000 drug-related fatalities between April 2020 and April 2021. This represents a 30% soar over the prior yr. And greater than three-quarters of those deaths had been attributed to opioid use alone.

For many individuals, opioid addiction begins with authentic prescription painkiller use after surgical procedure. Orthopedic and backbone situations account for almost 28% of all opioid prescriptions issued in the USA, the analysis crew mentioned in background notes. That has led specialists to hunt safer technique of minimizing post-surgical discomfort.

ACL surgical procedure is a typical operation, and “knee surgical procedure may cause excessive ranges of ache,” Okoroha mentioned.

However the excellent news is that the brand new research reveals that “with applicable multimodal administration, we are able to make this ache tolerable,” whereas eliminating opioid use, he added.

The findings had been revealed on-line not too long ago within the American Journal of Sports activities Drugs.

For the research, Okoroha’s crew examined their ache administration protocol with 34 sufferers who underwent ACL surgical procedure between February 2019 and January 2020.

All had been provided opioid-free ache medicines post-op, together with NSAIDs, acetaminophen and muscle relaxers. Ache ranges 10 days after ache therapy started had been in contrast with these of 28 different sufferers handled with an opioid remedy.

The investigators decided that ache aid was the identical throughout each teams, with no considerable variations when it comes to unwanted effects (dependancy danger apart), even after accounting for age, gender and physique mass index (a regular indicator of weight problems standing).

The findings do not shock one professional who was not a part of Okoroha’s research crew.

“I’ve truly had each of my ACLs reconstructed, so I do know the related ache properly,” mentioned Dr. David Katz, director of the Yale College Prevention Analysis Middle, in New Haven, Conn. “I imagine I used opioids for a day or two each instances, after which rapidly transitioned to non-opioid therapy.”

That therapy went past remedy. “An automatic, cooling compress across the surgical website supplied the best aid,” mentioned Katz.

“Based mostly on private expertise, I’m not in any respect stunned that opioids will be omitted from the routine, whereas preserving comparable ache administration,” he added.

However, Katz expressed some reservations in regards to the present research’s strategy.

“The routine on this research doesn’t impress me all that a lot, to be brutally sincere,” he mentioned. “It avoids opioids, which will be dangerously habit-forming, however features a benzodiazepine (Valium), which will be dangerously habit-forming. And there’s no point out of non-medication choices, such because the cooling compress I described,” Katz famous.

“As the location begins to heal, there’s a case for light therapeutic massage as properly. Really ‘multimodal’ ache aid isn’t just completely different medicines. It ought to embrace non-medication choices that work, too,” he prompt.

Nonetheless, Katz did not dismiss the work solely. “Typically, opioids are overused, whereas a variety of persistent ache is undertreated. So there may be actually a must broadcast any advance that may assist tackle these twin threats,” he mentioned.

Extra data

There’s extra on opioids and associated dangers on the U.S. Centers for Disease Control and Prevention.

SOURCES: Kelechi R. Okoroha, MD, orthopedic surgeon and sports activities harm specialist, division of sports activities drugs, Mayo Clinic, Minneapolis; David Katz, MD, MPH, director, Yale College Prevention Analysis Middle, New Haven, Conn.; American Journal of Sports activities Drugs, Oct. 20, 2021, on-line

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