Effect of Preoperative Counseling on Postoperative Opioid Use Following Knee Arthroscopy.
Condition: Opioid Use; Opioid-use Disorder
MeSH terms: Opioid-Related Disorders
Study type: Interventional

Summary: 
      Our study looks to evaluate the effect of brief preoperative counseling on opioid use
      following knee arthroscopy. We aim to quantify the effect we have as providers in changing
      patient behavior postoperatively in terms of the type and amount of pain medication that is
      utilized.
    

Detailed description: 
      Amid a national opioid epidemic, providers are looking for ways to minimize the utilization
      of narcotic and addictive pain medications while adequately treating acute and postoperative
      pain, all the while maintaining patient satisfaction. Much effort has been dedicated to
      studying non-narcotic alternative medications such as acetaminophen, NSAIDs, toradol,
      ketamine, ect., as well as multimodal strategies such as periaxial and perineural blockades.
      Little attention, however, has been given to the role we play as providers to help minimize
      the use of these addictive medications and the potential effect we have on changing patient
      behaviors. Alter et al1 published in the Journal of Hand Surgery their success of minimizing
      opioid use by simple preoperative counseling of patients undergoing carpal tunnel release
      surgery. They provided brief educational materials about the opioid epidemic and risks of
      these medications, as well as encouraging patients to utilize non-narcotic alternatives to
      control pain postoperatively. They saw a decrease in the amount of opioids used with no
      difference in pain scores in the group receiving this preoperative counseling.

      There are roughly 750,000 knee scopes performed each year in the United States. The incidence
      of chronic opioid use stemming from a short course of narcotics after elective knee
      arthroscopy has been shown to be up to 30%.2-4 The high volume of these procedures presents a
      unique opportunity to study trends in opioid use and pain control in the postoperative period
      in a prospective fashion.

      Study Design

      Patients scheduled to undergo knee arthroscopy by a single surgeon will be randomized into
      preoperative counseling or no counseling by simple randomization methods (computer generated
      "coin flip"). Those in the counseling group will receive a two minute talk during their
      preoperative appointment covering the risks of opioid medications, current public health
      situation regarding opioids, and alternative methods for pain control. They will also receive
      a one page document summarizing the Pennsylvania Orthopedic Society recommendations regarding
      opioid use that was used in previous research1. All patients will be prescribed the same pain
      medication and quantity (hydrocodone-acetaminophen 5-325 mg, 40 pills, 0 refills).
      Postoperatively, patients will be contacted via telephone on postoperative day three, asking
      what medication and how many pills they are taking daily for pain, as well as rating their
      daily pain level on a scale from 0-10. At their first postoperative follow-up appointment,
      they will again be asked about the quantity of pain medications used and pain level. After
      the first postoperative phone call, all data collection will be obtained at their regularly
      scheduled postoperative office visits, which occur at two and four weeks postoperatively.
      During all postoperative data collection time points we will also inquire and note all pain
      control measures, including ice, heat, compression, elevation, or other medications not
      commonly thought of as "pain medications". Data collection from each patient will be
      concluded at their one month postoperative visit.
    

Intervention name(s): Opioid counseling
Intervention type(s): Behavioral
Intervention description(s): The formal opioid counseling will involve reading the recommendations for postoperative opioid use established by the Pennsylvania Orthopedic Society.
Intervention MeSH terms: Analgesics, Opioid
Allocation: Randomized
Intervention model: Single Group Assignment
Intervention model description: Patients will be randomized into a treatment and control group.
Masking: None (Open Label)
Primary purpose: Prevention