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      Preoperative Patient Education May Decrease Postoperative Opioid Use After Meniscectomy

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          Abstract

          Purpose

          To identify the current opioid prescribing and use practices after arthroscopic meniscectomy and to evaluate the role of preoperative patient education in decreasing postoperative opioid consumption.

          Methods

          Patients undergoing arthroscopic meniscectomy were prospectively identified for inclusion. They were placed into 1 of 2 groups: Group 1 received no education regarding opioid use after surgery, whereas group 2 received a standardized overview on postoperative opioid use. Patients were assigned to the groups consecutively: Patients treated at the beginning of the study were assigned to group 1, and patients treated at the end of the study were assigned to group 2. Data from group 1 were used to identify “normal” opioid prescribing and use practices and to guide patients in group 2 regarding normal postoperative opioid use. Patients were surveyed weekly for 4 weeks after surgery to determine the number of opioids taken. Postoperative opioid consumption was analyzed and compared between the 2 groups.

          Results

          A total of 62 patients completed the study (32 in group 1 and 30 in group 2). Patients in group 1 were prescribed an average of 42.0 opioid pills (95% confidence interval [CI], 34.0-51.0 pills) and used an average of 15.84 pills (95% CI, 9.26-22.4 pills) after surgery, whereas patients in group 2 used an average of 4.00 pills (95% CI, 2.12-5.88 pills) after surgery. Patients in group 2 used 11.84 fewer opioid pills ( P = .001), a 296% decrease in postoperative opioid consumption. The number of patients who continued to take opioid pills 4 weeks after surgery was 7 patients (21.9%) in group 1 and 1 patient (3.3%) in group 2.

          Conclusions

          Preoperative patient education regarding opioids may decrease postoperative opioid consumption and the duration for which patients take opioid pills after arthroscopic meniscectomy.

          Level of Evidence

          Level II, prospective comparative study.

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          Most cited references21

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          Prescription Opioid Analgesics Commonly Unused After Surgery

          Prescription opioid analgesics play an important role in the treatment of postoperative pain; however, unused opioids may be diverted for nonmedical use and contribute to opioid-related injuries and deaths.
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            Characteristics of opioid prescriptions in 2009.

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              Vital signs: overdoses of prescription opioid pain relievers---United States, 1999--2008.

              (2011)
              Overdose deaths involving opioid pain relievers (OPR), also known as opioid analgesics, have increased and now exceed deaths involving heroin and cocaine combined. This report describes the use and abuse of OPR by state. CDC analyzed rates of fatal OPR overdoses, nonmedical use, sales, and treatment admissions. In 2008, drug overdoses in the United States caused 36,450 deaths. OPR were involved in 14,800 deaths (73.8%) of the 20,044 prescription drug overdose deaths. Death rates varied fivefold by state. States with lower death rates had lower rates of nonmedical use of OPR and OPR sales. During 1999--2008, overdose death rates, sales, and substance abuse treatment admissions related to OPR all increased substantially. The epidemic of overdoses of OPR has continued to worsen. Wide variation among states in the nonmedical use of OPR and overdose rates cannot be explained by underlying demographic differences in state populations but is related to wide variations in OPR prescribing. Health-care providers should only use OPRs in carefully screened and monitored patients when non-OPR treatments are insufficient to manage pain. Insurers and prescription drug monitoring programs can identify and take action to reduce both inappropriate and illegal prescribing. Third-party payers can limit reimbursement in ways that reduce inappropriate prescribing, discourage efforts to obtain OPR from multiple health-care providers, and improve clinical care. Changes in state laws that focus on the prescribing practices of health-care providers might reduce prescription drug abuse and overdoses while still allowing safe and effective pain treatment.
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                Author and article information

                Contributors
                Journal
                Arthrosc Sports Med Rehabil
                Arthrosc Sports Med Rehabil
                Arthroscopy, Sports Medicine, and Rehabilitation
                Elsevier
                2666-061X
                20 December 2019
                February 2020
                20 December 2019
                : 2
                : 1
                : e33-e38
                Affiliations
                [a ]Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York, U.S.A
                [b ]Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York, U.S.A
                [c ]Department of Orthopaedic Surgery and Sports Medicine, University of Connecticut, Farmington, Connecticut, U.S.A
                Author notes
                []Address correspondence to Steven M. Andelman, M.D., Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY 11203. steve.andelman@ 123456gmail.com
                Article
                S2666-061X(19)30027-6
                10.1016/j.asmr.2019.10.006
                7120832
                32266356
                82bde50d-d095-4c2b-97f5-b2443e540355
                © 2019 by the Arthroscopy Association of North America. Published by Elsevier Inc.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 29 June 2019
                : 8 October 2019
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