Dr. Lisa Friedman is a 2020–2021 Doximity Research Review Fellow. Nothing in this article is intended nor implied to constitute professional medical advice or endorsement. The views expressed in this article are those of the author and do not necessarily reflect the views/position of Doximity.
The opioid epidemic has increased scrutiny on prescribing practices in orthopaedic surgical procedures. While the risks of opioid misuse and long-term addiction have become clearer over time, perioperative opioid use may impact outcomes.
Given the ongoing opioid epidemic, preoperative opioid drug use by patients is a reality the orthopaedic surgeon faces. It is essential that we understand the implications of this preoperative factor on orthopaedic surgery outcomes. In a recent study, Lu et al. found that in patients undergoing shoulder arthroscopy, pre-op opioid use predicted worse patient-reported outcome scores, a lower likelihood of satisfaction in pain and function, an increased likelihood of persistent pain, higher revision rates, and an increased likelihood of continued opioid use at one year after surgery.
Shoulder arthroscopies are almost always elective procedures and identifying who is at risk for a poorer outcome is important for appropriately identifying a patient as a surgical candidate. In Lu et al.’s study, both the group that did and did not use pre-op opioids received a benefit from shoulder arthroscopy, demonstrating that pre-op narcotic use should not be an absolute contraindication to offering surgery. While some patients may ultimately decide to proceed with surgery, helping to set realistic expectations can help improve post-op satisfaction. For others, delaying or foregoing surgery altogether may represent a more appropriate treatment course.
This study provides valuable information to inform the surgeon’s management of post-op pain in patients who may be at higher risk of long-term opioid use. For high-risk patients, the use of multimodal analgesia and clear expectation-setting in the post-op period may prevent chronic opioid use following arthroscopic shoulder surgery. As such, this has important ramifications for clinical practice.
Lisa G. M. Friedman graduated from Case Western Reserve University with a medical degree and a master's degree in bioethics. She is currently the orthopaedic trauma research fellow at Geisinger Medical Center. Her interests include shoulder and trauma surgery, and she enjoys creative writing and playing sports in her free time. Dr. Friedman can be found on Twitter, @Shoulder2LeanOn.
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