Knee Arthroscopy, Shoulder Arthroscopy
Conditions
Brief summary
This is a randomized controlled trial of 200 patients between the ages of 18 and 65 years undergoing outpatient knee or shoulder arthroscopy. Patients will be evaluated clinically at 2 and 6 weeks post-operatively. Patients will be recruited from experienced arthroscopic surgeons at 3 hospital sites in Hamilton, Ontario. All research will be conducted according to international standards of Good Clinical Practice and institutional research policies and procedures.
Interventions
COMBINATION_PRODUCTNon-Opioid Prescription and Infographic
The study intervention will involve 3 components: 1. A standardized non-opioid prescription: A prescription for Naproxen 500mg PO BID PRN x 60 tabs, Acetaminophen 1000mg PO Q6H PRN x 100 500mg tabs and Pantoprazole 40mg PO daily x 30 tabs (to be taken only while utilizing Naproxen). 2. A limited opioid rescue prescription: A prescription of Hydromorphone 1mg PO Q4H PRN x 10 tabs will be included on a separate prescription. 3. Patient education infographic: The infographic will contain information on how to take the prescribed medications, along with instructions that the morphine rescue prescription should only be used in cases where the non-opioid pain medications are not providing satisfactory pain control.
Sponsors
Hamilton Health Sciences Corporation
The Physicians' Services Incorporated Foundation
McMaster University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Given that patients in the intervention group will receive a pamphlet explaining how to use their prescription allocation, patient blinding is not feasible. Surgeons cannot be blinded as they will need to sign the prescriptions and provide any necessary advice about the medications being prescribed. Outcome assessors and data analysts will be blinded.
Intervention model description
Eligible patients will be randomized using the centralized 24-hour computerized randomization system to allocate patients to the control (standard of care) or intervention (non-opioid prescription and infographic) group.
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
1. Patients undergoing outpatient knee or shoulder arthroscopy for any of the following procedures: ACL reconstruction (with or without LET), MPFL reconstruction (not including TTO), Chondroplasty, Meniscectomy, Meniscal repair Meniscal transplant, Microfracture, ACI, Fixation of unstable osteochondral lesion, Subacromial decompression, Rotator cuff repair, Shoulder stabilization, Superior capsule reconstruction, Biceps tenotomy/tenodesis, Capsular release, SLAP repair, Diagnostic arthroscopy, Irrigation and/or debridement, Loose body removal, Synovectomy 2. Patients aged 18 years and older 3. Patients who have the ability to speak, understand, and read English 4. Provision of informed consent
Exclusion criteria
1. Patients who take or are on a home dose of an opioid medication (i.e. once daily or more) 2. Patients involved in ongoing litigation or compensation claims for any injury (e.g. Work Safety Insurance Board, WSIB) 3. Patients involved in another research study that requires a specific post-operative pain control medication regimen 4. Patients undergoing a knee or shoulder arthroscopy procedure that will likely have an operative time greater than 3 hours 5. Patients who will undergo concomitant open surgery 6. Patients who require overnight admission 7. Patients with a contraindication or allergy to NSAIDs, acetaminophen, or morphine and hydromorphone 8. Patients diagnosed with renal disease or cardiac disease 9. Patients who are scheduled for/plan to have an additional surgical procedure during the 6-week follow-up period 10. Patients who will likely have problems, in the judgement of the investigator, with maintaining follow-up 11. Any other reason(s) the investigator feels is relevant for excluding the patient
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total oral morphine equivalents (OMEs) | 6 weeks postoperatively | The primary outcome is the number of total OMEs consumed as determined by a patient-reported medication diary. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain (Visual Analogue Scale, VAS) | 6 weeks postoperatively | The VAS will include a 100mm line, on which patients will be asked to rate their average pain since their surgery. |
| Patient Satisfaction (Hospital Consumer Assessment of Health Care Provider and Systems Question, HCAHPS) | 6 weeks postoperatively | We used the following modified question from the HCAHPS questionnaire related to satisfaction with pain relief, answered on a Likert scale (never, sometimes, usually, or always): In the time after surgery, how often was your pain well controlled? |
| OMEs Prescribed | 6 weeks postoperatively | As per the medication diary |
| Opioid Refills | 6 weeks postoperatively | As per the medication diary |
| Adverse Events | 6 weeks postoperatively | Adverse events, defined as any symptom, sign, illness, or experience that develops or worsens in severity during the course of this study, will be documented. |
Countries
Canada
Outcome results
None listed