Protocol for a multicenter randomized controlled trial comparing a non-opioid prescription to the standard of care for pain control following arthroscopic knee and shoulder surgery

NO PAin Investigators, Aaron Gazendam, Seper Ekhtiari, Nolan S Horner, Nicole Simunovic, Andrew Duong, Darren de Sa, Devin Peterson, Matthew Denkers, Vickas Khanna, Anthony Adili, Jaydeep Moro, Moin Khan, Olufemi R Ayeni, NO PAin Investigators, Aaron Gazendam, Seper Ekhtiari, Nolan S Horner, Nicole Simunovic, Andrew Duong, Darren de Sa, Devin Peterson, Matthew Denkers, Vickas Khanna, Anthony Adili, Jaydeep Moro, Moin Khan, Olufemi R Ayeni

Abstract

Background: Opioids continue to be the analgesic of choice for postoperative pain control following arthroscopic knee and shoulder surgery. Despite their widespread use, there are limited evidence-based clinical practice guidelines for postoperative opioid prescribing. The Non-Opioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) Trial is a randomized controlled trial (RCT) designed to determine whether a non-opioid analgesia approach to postoperative pain, compared to usual care, reduces oral morphine equivalents (OME) consumed in patients undergoing outpatient knee and shoulder arthroscopy.

Methods: This is a multi-centre, RCT with a target sample size of 200 patients. Adult (18+ years of age) patients undergoing outpatient knee and shoulder arthroscopy will be randomized to a non-opioid postoperative protocol (intervention) or the current standard of care (control). The intervention will consist of a standardized non-opioid analgesic prescription, a limited rescue opioid prescription, and a patient education infographic. The control is defined as the treating surgeons' pre-trial postoperative analgesic regimen. Exclusion criteria include chronic opioid use, concomitant open surgery, contraindications to the prescribed analgesics or ongoing workers compensation/litigation. The primary outcome is OMEs consumed at 6 weeks postoperatively. Secondary outcomes will include patient-reported pain and satisfaction, quantity of OMEs prescribed, number of opioid refills, and any adverse events up to 6 weeks postoperatively. Utilizing the intention to treat principle for all analyses, independent samples t-test and presented with a p-value as well as a mean difference (MD) with 95% confidence intervals (CIs) will be performed for primary and secondary outcomes.

Discussion: The ongoing opioid epidemic and overprescribing of opioids in orthopaedics serve as the rationale for this trial. There is a lack of evidence upon which to develop post-operative pain management guidelines for patients undergoing arthroscopic surgery. A prospective evaluation of this relatively inexpensive intervention will demonstrate whether an explicit effort to reduce the number of opioids prescribed results in a reduction in the amount of opioids consumed and help to inform future studies and guidelines.

Trial registration: The NO PAin trial has been prospectively registered with clinicaltrials.gov ( NCT04566250 ).

Keywords: Arthroscopy; Nonopioid; Opioid sparing; Randomized controlled trial.

Conflict of interest statement

Olufemi Ayeni is an Associate Editor of the BMC Musculoskeletal Disorders Journal.

Figures

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Study Timeline

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