The Effect of Preoperative Opioid Education on Patient’s Postoperative Opioid Usage Following Hip Arthroscopy: A Randomized, Prospective Trial

Philadelphia, PA

Introduction: Over the past twenty years, opioid usage has continued to rise significantly, resulting in what many have termed an “opioid epidemic”. Several studies have noted that patients are routinely over-prescribed opioids following common surgical procedures, resulting in a large number of unused and therefore readily available opioid pills. Additionally, the highest reported age population for illicit drug usage is in individuals ages 20-39 years old, which is the same group that commonly undergoes hip arthroscopy. A previous study in patients undergoing arthroscopic rotator cuff repair demonstrated that patients who received pre-operative opioid education consumed significantly less opioids 3 months after surgery than those patients who did not receive the pre-operative education. As a result, further investigation is necessary in patients undergoing hip arthroscopy to determine the potential effects opioid education materials have on this patient population. The primary objective of this study was to investigate the effect that a pre-operative opioid educational video has on patient’s opioid consumption following hip arthroscopy procedures.

Methods: This is a prospective, randomized trial enrolling patients undergoing arthroscopic hip surgery for either isolated or concomitant labrum repair, acetabuloplasty, or femoral osteoplasty. Exclusion criteria included a history of drug use, workman’s compensation, open surgery, patients <18 years of>age, and non-English speaking patients. Patients were randomly assigned a 1:1 ratio to either be shown an educational video detailing the risks of opioid utilization and dependence versus standard protocol. All patients received the current standard protocol for managing post-operative discomfort (local anesthetic injection at the time of surgery [20cc of ropivacaine intra-articularly], with 40 tablets of oxycodone 5mg/acetaminophen 325mg given for post-operative pain. All prescriptions were monitored through the state prescription monitors database and correlated with patient reporting. Physicians who performed the surgical procedure were blinded to which patients received patient education. Patients pain levels and opioid usage were determined through a custom narcotics use survey. Patients recorded their pain levels and opioid usage levels pre-operatively and then 2 weeks, 6 week, and 3 months after surgery. Included in each survey was the custom narcotic use survey, along with the Modified Harris Hip Score and Single Assessment Numeric Evaluation (SANE) rating. Number of opioid pills consumed was converted to morphine milligram equivalents for statistical analysis.

Results: Ninety-eight patients were included in the analysis (48 controls, 49 who received the opioid education). There were no significant differences between the two groups in mean age at surgery (31.5 in control and 32.0 in education group P=0.445), MI (24.6 and 24.7, P=0.790), or sex ratio (26M/23F in control and 22M/27F in education group (P=0.544). There were also no significant preoperative differences between the two groups in patient reported function, as measured by SANE (48.0 in control and 47.9 in education group, P=0.976) or patient reported pain and function as measured by Modified Harris Hip score (67.5 in control and 70.2 in education group, P=0.409). Patients in the education group had a significantly higher median morphine milligram equivalents (MME) consumed at 2 weeks (65.0 education vs. 30.0 control, P=0.013). However, there was no significant difference in the median MME consumed at 6 weeks (75.0 education vs 35.0 control, P=0.077), or 12 weeks (75.0 education vs 41.2 control, P=0.504). When the two groups were compared, there were no significant differences in duration of opioid consumption, as measured by the question” are you still taking narcotic medication to control your hip pain”, or patient reported pain and function as reported by the SANE scale an MHHS at 2 weeks, 6 weeks, and 12 weeks postoperatively. Power analysis revealed an effect size of 0.416 and power of 0.53 for mean MME consumed at 2 weeks.

Discussion and Conclusion: While those who received the preoperative education module on opioid medications actually demonstrated a higher mean amount of opioid pills consumed in the short term post-operative period at 2 weeks compared to the control group, they did not significantly differ from the control group at 6 and 12 weeks. Overall, the preoperative education module has no parent effect on patient-reported pain or function in the post-operative period.