OPIOID USE IN ADOLESCENTS FOLLOWING HIP AND KNEE ARTHROSCOPY
Authors: Willimon S. Clifton , Busch Michael , Christino Melissa , Schaafsma Belinda , Perkins Crystal 
Published: March 2019

Background:

The use and misuse of opioid medications has been declared an epidemic and public health emergency by the Centers for Disease Control. From 1999 – 2016, there was a 5-fold increase in overdose deaths secondary to opioids1. Pain control is an important component of post-operative care following orthopaedic surgery and opioid medications are commonly prescribed. The purpose of this study is to describe the average opioid use among adolescents following hip and knee arthroscopy.

Methods:

All patients less than 21 years of age undergoing ACL reconstruction, simple knee arthroscopy (plica and fat pad debridement, loose body removal, partial meniscectomy, or chondroplasty), and hip arthroscopy for femoroacetabular impingement were prospectively enrolled in this IRB-approved study. This is an interim report for an ongoing study with anticipated completion of enrollment in December 2018. All patients received hydrocodone-acetaminophen 5-325 mg for post-operative pain control. The number of pills prescribed was based on physician preference and was not dictated by the study. Patients and their families completed a medication logbook to track all doses of pain medication and associated pain scores. Risk factors for hydrocodone use following surgery were analyzed, including age, sex, race, pre-operative use of narcotic pain medications, surgical factors, and post-operative VAS pain scores.

Results:

A total of 65 patients were enrolled and completed the medication logbook, including 37 females and 28 males with a mean age of 15.6 years (range 7 – 20 years). Patients received a prescription for an average of 28 hydrocodone tablets (range 10 – 60) and 64 patients (98%) filled the prescription. The mean number and range of hydrocodone tablets consumed and remaining at the end of treatment and VAS pain scores at the time the patients consumed the pain medication are listed in the figure below. Forty-two patients (65%) reported one or more side effects from the hydrocodone, with the most common being drowsiness and constipation. There were no risk factors that predicted increased use of hydrocodone following ACL reconstruction or knee arthroscopy. Female sex and higher post-operative VAS pain scores predicted greater use of hydrocodone in patients following hip arthroscopy.

Conclusions:

Opioid medication use in adolescents following hip and knee arthroscopy is significantly less than the quantity of tablets prescribed, with 60% of the medication we prescribed remaining unused in the post-operative period. We recommend orthopaedic surgeons responsibly prescribe pain medications using evidence-based data or the results of their own experience monitoring medication consumption. Additionally, and important in the setting of the “opioid epidemic,” physicians must counsel patients and families of post-operative pain expectations and appropriate medication use. This study will provide the framework for the future development of educational resources regarding prescribing and use of pain medications for healthcare providers, patients, and caregivers. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2017 [Table: see text]