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      Narcotic Prescriptions following Knee and Shoulder Arthroscopy: A Survey of the Arthroscopy Association of Canada

      research-article
      1 , 2 , 3 , 3 , 3 , 1 ,
      ,
      Cureus
      Cureus
      narcotics, survey, prescription, patterns, arthroscopy, knee, shoulder, guidelines

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          Abstract

          Purpose

          Canada has the second-highest opioid use in the world. Despite knee and shoulder arthroscopy being among the most commonly performed orthopaedic procedures, there exists little guidelines for pain management.

          Methods

          A survey was developed and distributed to members of the Arthroscopy Association of Canada. The objectives were: to understand opioid prescribing patterns after knee and shoulder arthroscopy, to determine if surgeons believe opioid over-prescription is an issue and to identify other pain management strategies surgeons are regularly using.

          Results

          A total of 38 responses were included (38.3%). Eighty-two percent of surgeons felt opioid over-prescription was an issue in arthroscopic surgery. The average post-operative knee or shoulder arthroscopy prescription included a total of 156 +/- 84.4 (0-400) mg of oral morphine equivalents (OMEs). Less than one-third of respondents (29%) had received formal peri-operative pain management training. Fifty-five percent of respondents felt that non-opioid medications do not provide adequate pain relief after arthroscopic surgery. Nearly all respondents (95%) stated they would change their prescription practice if high-quality evidence were to suggest that they should do so.

          Conclusions

          The majority of respondents identified opioid over-prescription as a problem after arthroscopic surgery. Surgeons are prescribing five times the amount of OMEs to patients that previous literature suggests the median patient uses after arthroscopic knee surgery. Surgeons generally state they would reduce or eliminate opioid prescriptions to arthroscopy patients if high-level evidence were to emerge suggesting that adequate pain control could be achieved without the use of narcotics.

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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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            • Abstract: not found
            • Article: not found

            Characteristics of opioid prescriptions in 2009.

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              • Abstract: found
              • Article: not found

              The Neurobiology of Opioid Dependence: Implications for Treatment

              Opioid tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic opioid abuse. The opioid abuser’s struggle for recovery is in great part a struggle to overcome the effects of these changes. Medications such as methadone, LAAM, buprenorphine, and naltrexone act on the same brain structures and processes as addictive opioids, but with protective or normalizing effects. Despite the effectiveness of medications, they must be used in conjunction with appropriate psychosocial treatments.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                27 April 2020
                April 2020
                : 12
                : 4
                : e7856
                Affiliations
                [1 ] Orthopaedic Surgery, McMaster University, Hamilton, CAN
                [2 ] Division of Orthopaedic Surgery, Department of Surgery, Mcmaster University, Hamilton, CAN
                [3 ] Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, CAN
                Author notes
                Article
                10.7759/cureus.7856
                7255063
                32483506
                e1d38eb2-3a66-4185-805f-359a6d5a382f
                Copyright © 2020, Ekhtiari et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 March 2020
                : 25 April 2020
                Categories
                Pain Management
                Orthopedics

                narcotics,survey,prescription,patterns,arthroscopy,knee,shoulder,guidelines

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