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Perioperative nonopioid analgesia reduces postoperative opioid consumption in knee arthroscopy: a systematic review and meta-analysis

Knee Surgery, Sports Traumatology, Arthroscopy volume 29, pages 1887–1903 (2021)Cite this article

Abstract

Purpose

The opioid epidemic has prompted an emphasis on investigating opioid-sparing alternatives for pain management following knee arthroscopy. This review evaluated the effects of perioperative nonopioid adjunct analgesia on postoperative opioid consumption and pain control in patients undergoing knee arthroscopy.

Methods

A systematic review and meta-analysis was performed using the following databases: PubMed, Embase, Web of Science, MEDLINE, and SCOPUS. Prospective comparative studies assessing the efficacy of various perioperative nonopioid analgesic strategies in patients undergoing knee arthroscopy were included. Twenty-five studies (n = 2408) were included.

Results

Pre-emptive nonopioid pain medications demonstrated a reduction in cumulative postoperative oral morphine equivalent (OME) consumption by 11.8 mg (95% CI − 18.3, − 5.4, p ≤ 0.0001) and VAS pain scores by 1.5 (95% CI − 2.3, − 0.7, p < 0.001) at 24 h compared to placebo. Postoperative nonopioid pain medications significantly reduced cumulative postoperative OME consumption by 9.7 mg (95% CI − 14.4, − 5.1, p < 0.001) and VAS pain scores by 1.0 (95% CI − 1.354, − 0.633, p < 0.001) at 24 h compared to placebo. Saphenous nerve blocks significantly reduced cumulative postoperative OME consumption by 6.5 mg (95% CI − 10.3, − 2.6, p = 0.01) and VAS pain scores by 0.8 (− 1.4, − 0.3, p = 0.03) at 24 h compared to placebo. Both preoperative patient education and postoperative cryotherapy reduced postoperative opioid consumption.

Conclusion

Perioperative nonopioid pharmacotherapy, saphenous nerve blocks, and cryotherapy for patients undergoing knee arthroscopy significantly reduce opioid consumption and pain scores when compared to placebo at 24 h postoperatively. These interventions should be considered in efforts to reduce opioid consumption in patients undergoing knee arthroscopy. More research is needed to determine which interventions can reduce pain outside of the immediate postoperative period and the potential synergistic effects of combining interventions.

Level of evidence

II.

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Abbreviations

OME:

Oral morphine equivalent

VAS:

Visual analogue scale

CI:

Confidence interval

SD:

Standard deviation

MD:

Mean difference

RCT:

Randomized controlled trial

SNB:

Saphenous nerve block

NSAIDs:

Non-steroidal anti-inflammatories

ACL:

Anterior cruciate ligament

MINORS:

Methodological Index for Non-Randomized Studies

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Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Aaron Gazendam, Seper Ekhtiari, Nolan S. Horner & Olufemi R. Ayeni

  2. Northern Ontario School of Medicine, Thunder Bay, ON, Canada

    Nicholas Nucci

  3. Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Jared Dookie

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  1. Aaron Gazendam
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  2. Seper Ekhtiari
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Gazendam, A., Ekhtiari, S., Horner, N.S. et al. Perioperative nonopioid analgesia reduces postoperative opioid consumption in knee arthroscopy: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 29, 1887–1903 (2021). https://doi.org/10.1007/s00167-020-06256-2

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Keywords

  • Knee arthroscopy
  • Pain management
  • Opioid sparing
  • Meta-analysis