Preoperative education on pain self-management and opioid consumption does not significantly impact opioid use and disposal following shoulder arthroplasty: results of a prospective randomized controlled trial

Background

Prescription rates for opioid medications following orthopedic surgical procedures including shoulder arthroplasty continue to be high. In addition, only a small percentage of patients dispose of remaining opioid pills safely. The purpose of this study was to test the efficacy of preoperative education intervention on pain self-management, opioid consumption, and opioid disposal following shoulder arthroplasty.

Methods

A single-blinded prospective randomized trial was performed with subjects randomized to an education arm or a control arm and blinded to randomization status. The control group followed preoperative standard of care practices. The education group watched an educational video and received written educational material, focusing on pain self-management as well as responsible opioid use and disposal practices. Subjects in the education group were also provided with a prepaid and preaddressed envelope for opioid disposal. The primary outcome was the difference between groups in the proportion of patients who had 10 or more unused opioid pills remaining following surgery. The secondary outcome, opioid disposal rate, was also compared between groups. Comparisons were made using chi-square tests.

Results

A total of 127 participants were included for analysis. There were no significant differences between groups in age, body mass index, sex, smoking status, or type of procedure (anatomic vs. reverse shoulder arthroplasty) (all P > .05). There was no significant difference in median opioid consumption with or without preoperative education (15 pills vs. 21 pills, respectively, P = .7). There was no significant difference between education and control groups in proportion of patients with ≥10 unused pills (73% vs. 78%, P = .569). There was no difference in the rate of opioid disposal between education and control groups (37% vs. 31%, respectively, P = .5). However, when stratified by age, participants <70 years had significantly higher rates of disposal of unused opioids (49%) compared with those >70 years (29%, P = .041).

Discussion

Preoperative education and standardized disposal methods did not significantly impact opioid consumption and disposal following shoulder arthroplasty. Given the lack of significant impact of preoperative education on opioid consumption, this study highlights the need to consider other interventions in the postoperative setting that could be more beneficial in aiding with decreased opioid consumption and in promoting opioid disposal. Furthermore, these results can help surgeons avoid overprescribing and can inform surgeons on which patients are more likely to dispose of unused opioids following surgery.