Preoperative Education Significantly Decreases Postoperative Opioid Use after Arthroscopic Meniscectomy
Authors: Andelman Steven M. , Debellis Nicholas , Bu Daniel , Connecticut University of , Nwachukwu Chukwuma , Gladstone James N. , Colvin Alexis Chiang 
Published: July 2019

Objectives:

Arthroscopic meniscectomy is one of the most common procedures in orthopedic surgery and is thus a frequent reason for prescription of post-operative opioid narcotics. Recent emphasis has been placed on limiting the number of opioid pills given for post-operative analgesia, with the goal being to provide adequate post-operative pain control while minimizing the number of unused pills after surgery. A number of modifiable variables have been identified to prevent over-prescription of opioids including prescriber education and identification of patient-specific factors associated with increased opioid use. To date, no study has evaluated the role of patient education to decrease post-operative opioid use. The goal of this study is to determine the utility of pre-operative patient education in decreasing post-operative opioid consumption after arthroscopic meniscectomy.

Methods:

All patients 18 years and older from a group of five attending surgeons undergoing isolated arthroscopic unicompartmental meniscectomy were prospectively identified for inclusion in this cohort study. Patients were split into two groups: patients in Group 1 did not receive any specific education regarding opioid usage after surgery while patients in Group 2 received a formalized three-minute overview from a physician on both appropriate usage of opioid narcotics as well as options for non-narcotic post-operative analgesia. Patients were assigned to each group consecutively - all patients at the beginning of the study were assigned to Group 1 while all patients at the end of the study were assigned to Group 2. Post-operatively, patients in both groups were surveyed via phone call one, two, three, and four weeks after surgery to determine the number of opioid pills taken each week. Patient descriptive statistics and post-operative opioid consumption were analyzed and compared between the two groups.

Results:

62 patients completed the study, with 32 in Group 1 (no pre-operative education) and 24 in Group 2 (received pre-operative education). There were no significant demographic differences between the two groups. Patients in Group 1 used an average of 16.71 (95% CI, 9.67-23.75) opioid pills after surgery while patients in Group 2 used an average 3.21 (95% CI, 1.78-6.06) opioids after surgery. Patients in Group 2 used 13.5 less opioid pills (p = 0.001) representing a 420.0% decrease in post-operative opioid consumption over a four-week course (Figure 1). 7 (21.9%) patients in Group 1 continued to take opioid pills four weeks after surgery, while only 1 (4.2%) patient in Group 2 did the same.

Conclusion:

Pre-operative patient education regarding appropriate usage of opioid and options for non-narcotic analgesia significantly decreases post-operative opioid consumption and the duration which patients take opioid pills after arthroscopic meniscectomy. Pre-operative education is quick and inexpensive method to decrease post-operative opioid prescription requirements. [Figure: see text]