Perioperative Opioid Counseling for Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

Background: The use of opioids to manage pain after anterior cruciate ligament (ACL) reconstruction remains problematic. This study evaluated the impact of opioid-limiting perioperative pain management education and counseling on postoperative opioid consumption.

Methods: A parallel-arm, randomized controlled trial was conducted at a single academic institution. We included patients ≥14 years old who underwent ACL reconstruction surgery. Patients undergoing revision ACL surgery or open cartilage procedures, or who had a history of heroin use or opioid use requiring treatment, were excluded. A computer-based system randomly assigned participants in a 1:1 ratio to receive opioid-limiting perioperative pain management education and counseling with instructions to take opioids only as a last resort (treatment group) or traditional perioperative pain management with instructions to take opioids as needed for severe pain to "stay ahead of the pain" (control group). The primary outcome was the total morphine equivalents (TMEs) consumed in the 3 months after surgery. Secondary outcomes included pain measured with the Numeric Rating Scale, sleep quality, opioid prescription refills, and patient satisfaction.

Results: The trial enrolled 121 patients, with a mean age (and standard deviation [SD]) of 29 (12) years (67 [55%] male; 35 African American, 10 Asian, 69 White, and 7 other). Within 3 months after surgery, 60 patients assigned to the treatment group consumed a mean of 46.0 mg of TMEs (SD, 126.1) and 61 patients assigned to the control group consumed 63.6 mg of TMEs (SD, 83.4; p < 0.001). The average score on the Numeric Rating Scale for pain in the first 14 days was 2.5 (95% confidence interval [CI], 2.0 to 2.9) in the treatment group and 2.4 (95% CI, 1.9 to 2.9) in the control group (p = 0.82). Four patients (6.7%) in the treatment group and 6 patients (9.8%) in the control group refilled their oxycodone prescriptions within 3 months after surgery (p = 0.53). Sleep quality and patient satisfaction were similar between groups.

Conclusions: Among patients undergoing ACL reconstruction surgery, opioid-limiting pain management education and counseling reduced opioid consumption with no observed increase in postoperative pain. Clinicians should consider this easily implementable approach to reduce opioid use among patients undergoing this common procedure.

Level of evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.