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Opioids May Not Be Wanted After Knee Surgical procedure

By Alan Mozes
HealthDay Reporter

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

As america wrestles with skyrocketing charges of opioid abuse and drug overdose deaths, the findings could 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 drugs could 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 damage specialist with the Mayo Clinic in Minneapolis.

“Nonetheless, when used for lengthy intervals of time, opioids could be addicting,” Okoroha cautioned. And “when used incorrectly, or in excessive doses, opioids can have unintended effects, together with drowsiness, confusion, slowed respiration and even loss of life.”

Drug overdose deaths in america 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% leap over the prior yr. And greater than three-quarters of those deaths had been attributed to opioid use alone.

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

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

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

The findings had been revealed on-line lately within the American Journal of Sports activities Drugs.

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

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

The investigators decided that ache reduction was the identical throughout each teams, with no considerable variations by way of unintended effects (habit danger apart), even after accounting for age, gender and physique mass index (a normal indicator of weight problems standing).

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

“I’ve really had each of my ACLs reconstructed, so I do know the related ache effectively,” stated Dr. David Katz, director of the Yale College Prevention Analysis Heart, in New Haven, Conn. “I imagine I used opioids for a day or two each occasions, after which shortly transitioned to non-opioid remedy.”

That remedy went past treatment. “An automatic, cooling compress across the surgical web site offered the best reduction,” stated Katz.

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

However, Katz expressed some reservations concerning the present research’s method.

“The routine on this research doesn’t impress me all that a lot, to be brutally sincere,” he stated. “It avoids opioids, which could be dangerously habit-forming, however features a benzodiazepine (Valium), which could 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 mild therapeutic massage as effectively. Actually ‘multimodal’ ache reduction is not only completely different drugs. It ought to embody non-medication choices that work, too,” he steered.

Nonetheless, Katz did not dismiss the work fully. “Basically, opioids are overused, whereas a variety of persistent ache is undertreated. So there’s definitely a have to broadcast any advance that may assist tackle these twin threats,” he stated.

Extra info

There’s extra on opioids and associated dangers on the U.S. Facilities for Illness Management and Prevention.

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

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