Orthopedic surgery patients do fine without opioid painkillers

Opioid-based painkillers have become a mainstay of post-operative care in orthopaedics but carry a risk of addiction. Now a new study by researchers at McMaster University and Hamilton Health Sciences (HHS), suggests patients can recover from orthopaedic surgery just as well without using opioid-based painkillers. The findings, published by the Journal of the American Medical Association (JAMA), could have positive implications for efforts to reduce opioid use.

The research showed that by prescribing a combination of three non-opioid painkillers to patients, researchers successfully reduced approximately tenfold the amounts of opioids consumed over a six-week post-operative period, without altering their pain levels.

Prof Olufemi Ayeni and his team enrolled 193 patients between March 2021 and March 2022 from three Hamilton hospitals including HHS’ McMaster University Medical Centre and Hamilton General Hospital, and St. Joseph’s Healthcare Hamilton.

The patients were randomly assigned to either a control group of 98 receiving standard opioid-based painkillers or an opioid-free group (93) receiving a combination therapy of naproxen, acetaminophen and pantoprazole and a patient educational infographic. The opioid-free group did have access to opioid medication if required for pain. Each patient undergoing outpatient knee or shoulder arthroscopic surgery was monitored for six weeks after their operation.

After the six weeks, those in the control group had had an average of 72.6 mg of opioids, compared to 8.4 mg in the opioid-sparing group. Six patients in the control group and two patients in the opioid-sparing group asked for opioid medication after discharge. Difference in pain scores, patient satisfaction with care and number of adverse events were not significantly different.

‘This study clearly shows that many of these surgical patients can be treated safely without opioid medications in a select population,’ said Ayeni, professor of surgery at McMaster and an orthopaedic surgeon at HHS. ‘Furthermore, by reducing the number of opioids prescribed, we can collectively reduce the development of a reservoir of unused medications that can cause harm to many in society.’

There are an estimated 100,000 of these surgeries in Canada annually, meaning that shifting prescription practices to reduce opioid use can reduce patient exposure and, by extension, the potential for dependency on opioids, according to the authors. There are more than one million orthopaedic surgeries were performed annually in the United States from 2006 to 2016.

Opioids remain the post-operative painkiller of choice for many orthopaedic specialists, but North America’s ongoing opioid epidemic is forcing a rethink among clinicians, Ayeni said, adding that orthopaedic specialists at times prescribe more opioids than recommended by medical guidelines.