Randomized Controlled Trial

. 2023 Sep;31(9):4016-4026.

doi: 10.1007/s00167-023-07445-5. Epub 2023 May 12.

Multimodal analgesia did not improve post-operative pain scores, reduce opioid consumption or reduce length of stay following hip arthroscopy

Ryan M Degen^{1

2

3}, Andrew Firth⁴, Herman Sehmbi^{4

5}, Ashley Martindale⁴, Stacey Wanlin⁴, Clara Chen⁶, Jacqueline D Marsh⁶, Kevin Willits^{4

7

8}, Dianne Bryant^{4

7

8

6

9}

Affiliations

¹ Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, 3M Centre, London, ON, Canada. Ryan.degen@lhsc.on.ca.
² Bone and Joint Institute, Western University, London, ON, Canada. Ryan.degen@lhsc.on.ca.
³ Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Ryan.degen@lhsc.on.ca.
⁴ Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, 3M Centre, London, ON, Canada.
⁵ Department of Anesthesia, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁶ Faculty of Health Sciences, Western University, London, Canada.
⁷ Bone and Joint Institute, Western University, London, ON, Canada.
⁸ Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.

PMID: 37170015
DOI: 10.1007/s00167-023-07445-5

Randomized Controlled Trial

Multimodal analgesia did not improve post-operative pain scores, reduce opioid consumption or reduce length of stay following hip arthroscopy

Ryan M Degen et al. Knee Surg Sports Traumatol Arthrosc. 2023 Sep.

. 2023 Sep;31(9):4016-4026.

doi: 10.1007/s00167-023-07445-5. Epub 2023 May 12.

Authors

Ryan M Degen^{1

2

3}, Andrew Firth⁴, Herman Sehmbi^{4

5}, Ashley Martindale⁴, Stacey Wanlin⁴, Clara Chen⁶, Jacqueline D Marsh⁶, Kevin Willits^{4

7

8}, Dianne Bryant^{4

7

8

6

9}

Affiliations

¹ Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, 3M Centre, London, ON, Canada. Ryan.degen@lhsc.on.ca.
² Bone and Joint Institute, Western University, London, ON, Canada. Ryan.degen@lhsc.on.ca.
³ Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Ryan.degen@lhsc.on.ca.
⁴ Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, 3M Centre, London, ON, Canada.
⁵ Department of Anesthesia, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁶ Faculty of Health Sciences, Western University, London, Canada.
⁷ Bone and Joint Institute, Western University, London, ON, Canada.
⁸ Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.

PMID: 37170015
DOI: 10.1007/s00167-023-07445-5

Abstract

Purpose: To determine whether different regimens of multimodal analgesia will reduce postoperative pain scores, opioid consumption, costs and hospital length-of-stay following hip arthroscopy.

Methods: From 2018 to 2021, 132 patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) were included in this prospective, single-center randomized controlled trial. Patients were randomized into four treatment groups: (1) Group 1-Control: opioid medication (oxycodone-acetaminophen 5 mg/325 mg, 1-2 tabs q6H as needed), Heterotopic ossification prophylaxis-Naprosyn 500 mg twice daily × 3 weeks); (2) Group 2-Control + postoperative sleeping aid (Zopiclone 7.5 mg nightly × 7 days); (3) Group 3-Control + preoperative and postoperative Gabapentin (600 mg orally, 1 h preoperatively; 600 mg postoperatively, 8 h following pre-op dose); (4) Group 4-Control + pre-medicate with Celecoxib (400 mg orally, 1 h preoperatively) The primary outcome was pain measured with a visual analog scale, monitored daily for the first week and every other day for 6 weeks. Secondary outcomes included opioid consumption, healthcare resource use, and hospital length of stay.

Results: Patient characteristics were similar between groups. There were no statistically significant differences in pain scores between groups at any timepoint after adjusting for intra-operative traction time, intra-operative opioid administration and preoperative pain scores (p > 0.05). There were also no significant differences in the number of days that opioids were taken (n.s.) and the average daily morphine milligram equivalents consumed (n.s.). Similarly, there were no statistically significant differences in length of stay in the experimental groups, compared with the control group (n.s.). Finally, there were no differences in cost between groups (n.s.).

Conclusion: The routine use of Zopiclone, Celecoxib and Gabapentin did not improve postoperative pain control or reduce length-of-stay following hip arthroscopy. Therefore, these medications are not recommended for routine postoperative pain control following hip arthroscopy.

Level of evidence: l.

Keywords: Hip arthroscopy; Multimodal analgesia; Opioid; Pain.

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References

References:

1. Abebe MM, Arefayne NR, Temesgen MM, Admass BA (2022) Evidence-based perioperative pain management protocol for day case surgery in a resource limited setting: systematic review. Ann Med Surg. https://doi.org/10.1016/j.amsu.2022.104322 - DOI
1. Acuña AJ, Jella TK, Samuel LT, Cwalina TB, Kim TS, Kamath AF (2021) A work in progress: national opioid prescription reductions across orthopaedic subspecialties in a contemporary medicare sample of 5,026,911 claims. J Am Acad Orthop Surg Glob Res Rev 5:1–12. https://doi.org/10.5435/JAAOSGlobal-D-21-00080 - DOI
1. Bronstone AB, Leonardi C, Kubilay T, Plessl DS, Morreale PJ, Tortorich GM, Krause PC (2022) Dramatic reduction in opioid prescribing for common outpatient orthopaedic lower extremity surgical procedures at a Louisiana University-Based Safety-Net Hospital after enactment of opioid-limiting state legislation. J Am Acad Orthop Surg 30:e405–e414. https://doi.org/10.5435/JAAOS-D-21-00390 - DOI - PubMed
1. Cunningham DJ, George SZ, Lewis BD (2020) The impact of state level public policy, prescriber education, and patient factors on opioid prescribing in elective orthopedic surgery: findings from a tertiary, academic setting. Mayo Clin Proc Innov Qual Outcomes 5:23–34 - DOI - PubMed - PMC
1. Cunningham DJ, Kwon NF, Allen NB, Hanselman AM, Adams SB (2021) Time and state legislation have decreased opioid prescribing in elective foot and ankle surgery in the United States. Foot Ankle Spec. https://doi.org/10.1177/19386400211043361 - DOI - PubMed

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Multimodal analgesia did not improve post-operative pain scores, reduce opioid consumption or reduce length of stay following hip arthroscopy

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Multimodal analgesia did not improve post-operative pain scores, reduce opioid consumption or reduce length of stay following hip arthroscopy

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