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Opioid-Free Carpometacarpal Joint Arthroplasty: Post-Operative Results from a Double-Blind Randomized Controlled Trial
Krishna N. Chopra, MA; Musab Gulzar, BS; Hayden L. Cooke, BS; Paul A. Ghareeb, MD; Amanda L. Dempsey, MD; Nina Suh, MD; Michael B. Gottschalk, MD; Eric R. Wagner, MD
Emory University School of Medicine, Atlanta, GA
INTRODUCTION: Trends in opioid usage are an important consideration for post-operative pain management. Orthopaedics is one of the top subspecialties to prescribe opioids in the United States.1 To reduce the need for post-operative opioids, surgeons at our institution utilize a multimodal treatment protocol including a steroid dose pack, acetaminophen, and naproxen. This study aimed to see if this approach was sufficient for pain management without opioids. MATERIALS & METHODS: Patients undergoing carpometacarpal (CMC) joint arthroplasty were randomly assigned to receive either oxycodone or a placebo study drug. All patients received a standardized multimodal post-operative pain management protocol, including a rescue oxycodone prescription. Patients were asked to keep a pain journal and record Visual Analog Scale (VAS) pain and nausea three times a day as well as the number of study and rescue drugs consumed daily for two weeks after surgery. RESULTS: 47 patients were included in the final analysis – 23 received the placebo study drug, and 24 received the oxycodone study drug. Demographic characteristics were similar between both groups (Table 1). Analysis of VAS pain scores from post-op day 0 to day 15 demonstrated no significant difference in average pain except for day 5 (placebo group: 3.7 ± 2.4, oxycodone group: 2.5 ± 2.5; p=.048). There were no significant differences in nausea scores between groups. While patients in the placebo group took more pills on average than those in the oxycodone group (9.9 ± 14.6 vs 5.4 ± 13.4, respectively; p=0.32), there was no significant difference in the cumulative number of opioids taken by each group (4.8 ± 8.5 vs 5.4 ± 13.4, respectively; p=.408) or the cumulative oral morphine equivalents (OME) consumed (7.2 ± 12.7 vs 8.1 ± 20.1, respectively; p=.408). Of the 47 patients included in our analysis, 39 took ? 7 pills of oxycodone during recovery. CONCLUSIONS: During the first two weeks post-operatively, there were overall no significant differences in pain and nausea between the placebo and oxycodone groups. Both groups consumed a similar total number of oxycodone pills, with 83% of patients taking ? 7 pills. This study suggests that while opioids may still be necessary in conjunction with a multimodal treatment protocol after CMC arthroplasty, surgeons can drastically reduce the number of pills prescribed for pain management. REFERENCES: Jiang X, Orton M, Feng R, et al.: Chronic opioid usage in surgical patients in a large academic center. Ann Surg 2017; 265:722-727. 
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