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The purpose of the study is to determine if opiates are required to achieve adequate analgesia after knee arthroscopy and ACL reconstruction in outpatient surgery.
The investigators hypothesize that patients are frequently prescribed more opiates than are needed after surgery, resulting in excess medications that are at risk for misuse, diversion and contribution to the opioid epidemic.
Perioperative pain management is an important aspect of quality patient care. Opioid pain medications are increasingly being used for pain control, with the United States writing over 250 million prescriptions for painkillers per year. Increased usage has led to unintended negative consequences for individuals and society. It is estimated that 46 people die each day from an overdose of prescription painkillers, and individual use can lead to the development of tolerance and worse treatment outcomes. Further issues arise when opioids are misused, it is estimated that non-therapeutic use has increased three fold in recent years. In the United States alone in 2006 the estimated total cost of opioid prescription misuse was $53.4 billion, of which $42 billion was attributed to lost productivity, $8.2 billion to criminal justice cost and the remainder drug abuse treatment and medical complications. The federal government has recognized this epidemic and raised a call for clinicians to more responsibly prescribe opiate pain medications.
Opiate use has increased in recent years, from 2000-2010 the use of opiates in office based visits nearly doubled from 11.3% to 19.6% whereas there was no change in the prescribing of non-opioid pharmacotherapies. Further, when specifically looking at new musculoskeletal pain visits, one half resulted in pharmacologic treatment, with the prescribing of non-opioid pharmacotherapies decreasing from 38% to 29% from 2000 to 2010, respectively. The clinical use of opioids for post-operative pain control has also been linked to the opioid epidemic and risk of future abuse. Legitimate opioid use before high school graduation is independently associated with a 33% increased risk of future misuse after high school.
It has been estimated that orthopedic surgeons prescribe 7.7% of all opioids in the United States.Special attention needs to be paid to the amount of opioid pain medications orthopedic surgeons prescribe to patients after ambulatory surgery, there is considerable variability among surgeon and procedure in regards to the amount of opioids to prescribe with many patients left with excess unused medication.An analysis of 250 patients undergoing outpatient upper extremity surgery found that on average patients consumed 10 opioid pills, with 19 pills left over and a total of 4,639 pills going unused in the cohort. Leftover prescription opioids are at risk for diversion to family and friends for nonmedical use. Further studies are needed to quantify the amount of opioids to prescribe for specific orthopedic procedures to limit excess narcotic use, misuse, diversion and contribution to the opioid epidemic.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1-Knee Arthroscopy | Experimental | Will have all of their post-operative prescriptions sent down to the pharmacy on the day of surgery to be collected. |
|
| Group 2-Knee Arthroscopy | Experimental | Will have all prescriptions sent to pharmacy with the exception of an opiate prescription. Instead, they will be handed a physical paper prescription. They will be instructed to only fill the prescription if absolutely needed. |
|
| Group 1-ACL reconstruction | Experimental | Will be prescribed 60 opiate tablets in addition to other routine post-operative pain medication regimens. |
|
| Group 2-ACL reconstruction | Experimental | Will be prescribed 30 opiate tablets in addition to other routine post-operative pain medication regimens. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Group 1-Knee Arthroscopy | Other | Will have all of their post-operative prescriptions sent down to the pharmacy on the day of surgery to be collected. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Numeric Pain Rating Scale (NPRS) Pain Score | 2 hours post-op; minimum score: 0 = no pain, maximum score: 10 = worst imaginable pain; lower value is better | 2 hours post-op |
| Opiate Count | 24 hours post-op | 24 hours post-op |
| Side Effects, 24 Hours Post-op | Number of Participants with Side Effects, 24 hours post-op | 24 hours post-op |
| Numeric Pain Rating Scale (NPRS) Pain Scores | 48 hours post-op; minimum score: 0 = no pain, maximum score: 10 = worst imaginable pain; lower value is better | 48 hours post-op |
| Opiate Count | 48 hours post-op | 48 hours post-op |
| Side Effects | 48 hours post-op | 48 hours post-op |
| Numeric Pain Rating Scale (NPRS) Pain Scores | 7 days post-op; minimum score: 0 = no pain, maximum score: 10 = worst imaginable pain; lower value is better | 7 days post-op |
| Opiate Count | Number Pills Taken | 7 days post-op |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Northwestern Medicine Department of Orthopaedic Surgery | Chicago | Illinois | 60611 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32755488 | Derived | Hartwell MJ, Selley RS, Terry MA, Tjong VK. Can We Eliminate Opioid Medications for Postoperative Pain Control? A Prospective, Surgeon-Blinded, Randomized Controlled Trial in Knee Arthroscopic Surgery. Am J Sports Med. 2020 Sep;48(11):2711-2717. doi: 10.1177/0363546520941861. Epub 2020 Aug 5. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Group 1 (Filled)-Knee Arthroscopy | Will have all of their post-operative prescriptions sent down to the pharmacy on the day of surgery to be collected. Group 1-Knee Arthroscopy: Will have all of their post-operative prescriptions sent down to the pharmacy on the day of surgery to be collected. |
| FG001 | Group 2 (as Needed)-Knee Arthroscopy | Will have all prescriptions sent to pharmacy with the exception of an opiate prescription. Instead, they will be handed a physical paper prescription. They will be instructed to only fill the prescription if absolutely needed. Group 2-Knee Arthroscopy: Will have all prescriptions sent to pharmacy with the exception of an opiate prescription. Instead, they will be handed a physical paper prescription. They will be instructed to only fill the prescription if absolutely needed. |
| FG002 | Group 1 (60)-ACL Reconstruction | Will be prescribed 60 opiate tablets in addition to other routine post-operative pain medication regimens. Group 1-ACL reconstruction: Will be prescribed 60 opiate tablets in addition to other routine post-operative pain medication regimens. |
| FG003 | Group 2(30)-ACL Reconstruction | Will be prescribed 30 opiate tablets in addition to other routine post-operative pain medication regimens. Group 2-ACL reconstruction: Will be prescribed 30 opiate tablets in addition to other routine post-operative pain medication regimens. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Group 1 (Filled)-Knee Arthroscopy | Will have all of their post-operative prescriptions sent down to the pharmacy on the day of surgery to be collected. Group 1-Knee Arthroscopy: Will have all of their post-operative prescriptions sent down to the pharmacy on the day of surgery to be collected. |
| BG001 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Numeric Pain Rating Scale (NPRS) Pain Score | 2 hours post-op; minimum score: 0 = no pain, maximum score: 10 = worst imaginable pain; lower value is better | Posted | Mean | Standard Deviation | score on a scale | 2 hours post-op |
|
21 days post-surgery
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Group 1-Knee Arthroscopy | Will have all of their post-operative prescriptions sent down to the pharmacy on the day of surgery to be collected. Group 1-Knee Arthroscopy: Will have all of their post-operative prescriptions sent down to the pharmacy on the day of surgery to be collected. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Melissa Shauver; Research Project Manager | Northwestern University | 3124726024 | melissa.shauver1@nm.org |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Jan 29, 2020 | Jul 29, 2020 | Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | May 23, 2020 | Jul 29, 2020 | SAP_001.pdf |
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| ID | Term |
|---|---|
| D007718 | Knee Injuries |
| D000070598 | Anterior Cruciate Ligament Injuries |
| ID | Term |
|---|---|
| D007869 | Leg Injuries |
| D014947 | Wounds and Injuries |
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| Group 2-Knee Arthroscopy | Other | Will have all prescriptions sent to pharmacy with the exception of an opiate prescription. Instead, they will be handed a physical paper prescription. They will be instructed to only fill the prescription if absolutely needed. |
|
| Group 1-ACL reconstruction | Other | Will be prescribed 60 opiate tablets in addition to other routine post-operative pain medication regimens. |
|
| Group 2-ACL reconstruction | Other | Will be prescribed 30 opiate tablets in addition to other routine post-operative pain medication regimens. |
|
| Number of Participants With Side Effects | Potential side effects included lightheadedness, nausea, drowsiness, gastrointestinal symptoms, constipation | 7 days post-op |
| Refill Requests | Number of participants requesting opioid refills within 3 months after surgery | Within 3 months after surgery |
| Still Taking Opiates? | Number of patients who took any opiates between surgery and 1 day postoperative | 1 day postoperative |
| Still Taking Opiates? | Number of patients who took any opiates between 1 day and 2 days postoperative | 2 days postoperative |
| Still Taking Opiates? | Number of patients who took any opiates between 2 days and 7 days postoperative | 7 days postoperatively |
| Still Taking Opiates? | Number of patients who took any opiates between 7 days and 21 days postoperative | 21 days postoperatively |
| Group 2 (as Needed)-Knee Arthroscopy |
Will have all prescriptions sent to pharmacy with the exception of an opiate prescription. Instead, they will be handed a physical paper prescription. They will be instructed to only fill the prescription if absolutely needed. Group 2-Knee Arthroscopy: Will have all prescriptions sent to pharmacy with the exception of an opiate prescription. Instead, they will be handed a physical paper prescription. They will be instructed to only fill the prescription if absolutely needed. |
| BG002 | Group 1 (60)-ACL Reconstruction | Will be prescribed 60 opiate tablets in addition to other routine post-operative pain medication regimens. Group 1-ACL reconstruction: Will be prescribed 60 opiate tablets in addition to other routine post-operative pain medication regimens. |
| BG003 | Group 2 (30)-ACL Reconstruction | Will be prescribed 30 opiate tablets in addition to other routine post-operative pain medication regimens. Group 2-ACL reconstruction: Will be prescribed 30 opiate tablets in addition to other routine post-operative pain medication regimens. |
| BG004 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | Years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
|
| Body Mass Index | Mean | Standard Deviation | kg/m^2 |
|
| Are you an active smoker? | Count of Participants | Participants |
|
| If no, have you ever consistently smoked cigarettes (daily for >1 month)? | Among participants who are not current smokers | Count of Participants | Participants |
|
| What is your employment status? | Count of Participants | Participants |
|
| Is this injury part of a workers compensation claim? | Count of Participants | Participants |
|
| Are you actively participating in sporting activities? | Count of Participants | Participants |
|
| At what level (i.e. professional, collegiate, recreational)? | Count of Participants | Participants |
|
| Are you currently using narcotic pain medications (ex. Norco, Vicodin, Oxycontin/Oxycodone) ? | Count of Participants | Participants |
|
| Do you have a personal history of illicit substance abuse? | Count of Participants | Participants |
|
| Do you have a family history of illicit substance abuse? | Count of Participants | Participants |
|
| What is the highest level of education you have attained? | Count of Participants | Participants |
|
| What is your average yearly household income? | Count of Participants | Participants |
|
| OG002 | Group 1-ACL Reconstruction | Will be prescribed 60 opiate tablets in addition to other routine post-operative pain medication regimens. Group 1-ACL reconstruction: Will be prescribed 60 opiate tablets in addition to other routine post-operative pain medication regimens. |
| OG003 | Group 2-ACL Reconstruction | Will be prescribed 30 opiate tablets in addition to other routine post-operative pain medication regimens. Group 2-ACL reconstruction: Will be prescribed 30 opiate tablets in addition to other routine post-operative pain medication regimens. |
|
|
| Primary | Opiate Count | 24 hours post-op | Posted | Mean | Standard Deviation | pills | 24 hours post-op |
|
|
|
| Primary | Side Effects, 24 Hours Post-op | Number of Participants with Side Effects, 24 hours post-op | Posted | Count of Participants | Participants | 24 hours post-op |
|
|
|
| Primary | Numeric Pain Rating Scale (NPRS) Pain Scores | 48 hours post-op; minimum score: 0 = no pain, maximum score: 10 = worst imaginable pain; lower value is better | Posted | Mean | Standard Deviation | score on a scale | 48 hours post-op |
|
|
|
| Primary | Opiate Count | 48 hours post-op | Posted | Mean | Standard Deviation | pills | 48 hours post-op |
|
|
|
| Primary | Side Effects | 48 hours post-op | Posted | Count of Participants | Participants | 48 hours post-op |
|
|
|
| Primary | Numeric Pain Rating Scale (NPRS) Pain Scores | 7 days post-op; minimum score: 0 = no pain, maximum score: 10 = worst imaginable pain; lower value is better | Posted | Mean | Standard Deviation | score on a scale | 7 days post-op |
|
|
|
| Primary | Opiate Count | Number Pills Taken | Posted | Mean | Standard Deviation | Pills Hydrocodone/Acetaminophen 10/325mg | 7 days post-op |
|
|
|
| Primary | Number of Participants With Side Effects | Potential side effects included lightheadedness, nausea, drowsiness, gastrointestinal symptoms, constipation | Posted | Count of Participants | Participants | 7 days post-op |
|
|
|
| Primary | Refill Requests | Number of participants requesting opioid refills within 3 months after surgery | Posted | Count of Participants | Participants | Within 3 months after surgery |
|
|
|
| Primary | Still Taking Opiates? | Number of patients who took any opiates between surgery and 1 day postoperative | Posted | Count of Participants | Participants | 1 day postoperative |
|
|
|
| Primary | Still Taking Opiates? | Number of patients who took any opiates between 1 day and 2 days postoperative | Posted | Count of Participants | Participants | 2 days postoperative |
|
|
|
| Primary | Still Taking Opiates? | Number of patients who took any opiates between 2 days and 7 days postoperative | Posted | Count of Participants | Participants | 7 days postoperatively |
|
|
|
| Primary | Still Taking Opiates? | Number of patients who took any opiates between 7 days and 21 days postoperative | Posted | Count of Participants | Participants | 21 days postoperatively |
|
|
|
| 0 |
| 48 |
| 0 |
| 48 |
| 0 |
| 48 |
| EG001 | Group 2-Knee Arthroscopy | Will have all prescriptions sent to pharmacy with the exception of an opiate prescription. Instead, they will be handed a physical paper prescription. They will be instructed to only fill the prescription if absolutely needed. Group 2-Knee Arthroscopy: Will have all prescriptions sent to pharmacy with the exception of an opiate prescription. Instead, they will be handed a physical paper prescription. They will be instructed to only fill the prescription if absolutely needed. | 0 | 47 | 0 | 47 | 0 | 47 |
| EG002 | Group 1-ACL Reconstruction | Will be prescribed 60 opiate tablets in addition to other routine post-operative pain medication regimens. Group 1-ACL reconstruction: Will be prescribed 60 opiate tablets in addition to other routine post-operative pain medication regimens. | 0 | 43 | 0 | 43 | 0 | 43 |
| EG003 | Group 2-ACL Reconstruction | Will be prescribed 30 opiate tablets in addition to other routine post-operative pain medication regimens. Group 2-ACL reconstruction: Will be prescribed 30 opiate tablets in addition to other routine post-operative pain medication regimens. | 0 | 42 | 0 | 42 | 0 | 42 |
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| Between 18 and 65 years |
|
| >=65 years |
|
| Male |
|
| No |
|
| No |
|
| Unemployed |
|
| Disabled |
|
| Retired |
|
| No |
|
| No |
|
| Collegiate |
|
| Recreational |
|
| N/A |
|
| No |
|
| No |
|
| No |
|
| Undergraduate |
|
| Graduate |
|
| $20,000 -$34,999 |
|
| $35,000 -$49,999 |
|
| $50,000 -$74,999 |
|
| $75,000 - $99,999 |
|
| $100,000 -$149,999 |
|
| $150,000 - $199,999 |
|
| $200,000 or more |
|
| No |
|
| No |
|
| No |
|
| No |
|