Multimodal Nonopioid Protocol Eases Pain After ACL Repair

FRIDAY, Feb. 11, 2022 (HealthDay News) -- A multimodal nonopioid pain protocol may offer adequate relief from postoperative pain for some patients undergoing anterior cruciate ligament reconstruction (ACLR) or primary rotator cuff repair, according to two studies recently published online in The American Journal of Sports Medicine and Arthroscopy: The Journal of Arthroscopic & Related Surgery.

Vasilios Moutzouros, M.D., from the Henry Ford Health System in Detroit, Michigan, and colleagues randomly assigned patients with ACLR to receive either a standard opioid regimen or a multimodal nonopioid analgesic regimen (acetaminophen, ketorolac, diazepam, gabapentin, and meloxicam; 28 and 34 patients, respectively) and measured pain scores for the first 10 postoperative days. The researchers found that compared with patients who received opioid pain medication, those receiving the multimodal nonopioid pain regimen demonstrated significantly lower visual analog scale (VAS) scores. There was no significant difference observed between the groups in the patients' preoperative or one-week postoperative scores on the Patient-Reported Outcomes Measurement and Information System Pain Interference (PROMIS-PI) Short Form.

Toufic R. Jildeh, M.D., from the Steadman Philippon Research Institute in Vail, Colorado, and colleagues compared a multimodal nonopioid pain regimen to standard-of-care narcotics for patients with a primary rotator cuff repair (17 and 23, respectively) and measured pain scores for the first 10 postoperative days. The researchers found that on postoperative days 1 and 4, the VAS pain score was significantly higher for control patients on opioid pain management. On other postoperative days, no significant difference was seen. After adjustment for potential confounders, the nonopioid group demonstrated significantly lower VAS and PROMIS-PI scores.

"I think this is really game-changing research," a coauthor on both studies said in a statement. "We've found that it is effective in common sports surgeries. So our plan is to implement it in other surgeries and hopefully decrease the opioid burden worldwide."

Several authors from both studies disclosed financial ties to the medical device industry.

Abstract/Full Text - Moutzouros (subscription or payment may be required)

Abstract/Full Text - Jildeh (subscription or payment may be required)