Novel Protocol Reduced Use of Opioid Pain Relievers After Knee and Shoulder Surgeries What are the main findings?

Response: Our results show that the opioid reduction strategy used in the study was effective in reducing the amount of opioids prescribed and used by about 10-fold each (mean difference, 64.2 mg; 95% confidence interval, 44.4-84.0, p<0.001) among patients undergoing arthroscopic knee and shoulder surgery, without a significant difference in pain levels or patient satisfaction. What should readers take away from your report?

Response: The results of this trial provide a novel approach to the management of pain following knee and shoulder arthroscopy. The combination of non-opioid analgesics alongside patient education is a simple approach that has the potential to be widely applied and reduce the negative effects of opioid overuse.These results may shift prescription practices to reduce opioid use, thereby reducing patient exposure, and by extension, the potential for dependency on opioids.  Furthermore, by reducing the number of opioids prescribed, we can collectively reduce the development of a reservoir of unused medications that can cause harm to many in society. What recommendations do you have for future research as a result of this study?

Response: The current study provides evidence to support an opioid-sparing approach to postoperative pain management following arthroscopic surgery. There is a need for high level evidence in other areas of orthopaedic surgery to evaluate the efficacy of similar protocols in other patient populations.


The NO PAin Investigators. Effect of a Postoperative Multimodal Opioid-Sparing Protocol vs Standard Opioid Prescribing on Postoperative Opioid Consumption After Knee or Shoulder Arthroscopy: A Randomized Clinical Trial. JAMA. 2022;328(13):1326–1335. doi:10.1001/jama.2022.16844

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Last Updated on October 5, 2022 by