A Prospective Pilot Study in Hip Arthroscopy: How many opiates should we prescribe for pain?
Ryan S. Selley, MD, Bennet A. Butler, MD, Daniel J. Johnson, MD, Charles J. Cogan, BA, Michael A. Terry, MD, Vehniah K. Tjong, MD.
Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
Orthopedic surgeons frequently use opioids for peri-operative pain management and there is considerable variability in the amount prescribed between surgeons. As such, the appropriate number of opioids to prescribe for specific procedures is often unknown. Leftover prescription opioids are at risk for diversion to family and friends for nonmedical use. The aim of this study was to determine the optimal amount of narcotics to prescribe postoperatively for patients undergoing hip arthroscopy.
Methods & Materials
Patients scheduled to undergo hip arthroscopy by two fellowship-trained surgeons at a single urban academic institution were enrolled after undergoing informed consent preoperatively. All eligible patients were required to complete a pre-operative demographic questionnaire asking the following: Age, Sex, Height, Weight, Smoking Status, Employment status, worker’s compensation injury, current sports participation, current narcotic use, personal or family history of illicit substance abuse and level of education attained. Patients were subsequently called between 7-14 days post-operatively and asked the total number of opiate tablets consumed, the day they stopped taking opioid tablets, and if they knew how to properly dispose of excess pills. Patient baseline characteristics, known predictors of opioid abuse and surgical information are reported as means ± standard deviation for continuous variables and percentages for categorical data. Patients were split into those requiring greater than 3 days of narcotics postoperatively and those requiring 3 days or less. The aforementioned characteristics were compared using Student’s t-test and Pearson Chi Square as appropriate. Postoperative duration and amount of narcotic use were entered into a univariate linear regression analysis along with the variables of interest. Only one variable was significant in the univariate analysis, as such no multivariate analysis is reported. Results are reported as parameter estimates with 95% confidence intervals. P < 0.05 (two-tailed) was considered to be significant.
Patients who discontinued narcotic use within 3 days or less were more likely to have knowledge of proper disposal techniques (p=0.029). No other demographic factors, preoperative questionnaire, or surgical characteristics were associated with number of days or amount of narcotic medication required. When analyzing our cohort we noted that 56.5% of patients required 10 narcotic pain pills or less. All patients undergoing hip arthroscopy were prescribed 60 tablets. This led to a total of 1071 narcotic tablets unused out of a total of 1380 prescribed (77.6%). Only 34.8% of patients knew how to properly dispose of unused narcotics.
On average, patients required 13.4 ± 17.4 narcotic pills per hip arthroscopy. The median number of pills required for per procedure postoperatively was 6 (25th percentile: 3, 75th percentile 15). Prescribing 25 pills would meet the narcotic needs of greater than 85% of patients and decrease the number of unused narcotics by two-thirds.