Editorial Commentary: Multimodal, Opioid-Free Pain Management After Rotator Cuff Repair May Be Safe and Effective, and Decreases the Risk of Drug Abuse.

In 2020, approximately 94,000 people died in the United States due to drug overdose, a grim 78% increase since release of the American Academy of Orthopaedic Surgeons (AAOS) information statement on opioid abuse nearly 5 years ago. Annual opioid-related mortality rates now far surpass those stemming from either car crashes or gun violence. Multiple risk factors exist for opioid misuse and abuse, including a major risk factor under the orthopaedic surgeon's control-exposure to opioid medication. Prescription protocols that decrease a patient's access to narcotic medication could lead to a decrease in overall opioid abuse, while also avoiding second-order effects, such as drug diversion. Multimodal, nonopioid pain protocols often employ peripheral nerve blocks, acetaminophen, nonsteroidal anti-inflammatory medication (NSAIDs), gabapentinoids, and antispasmodic muscle relaxants, and this has yielded promising results after arthroscopic rotator cuff surgery. As good stewards of the musculoskeletal community, we should proactively employ evidence-based practices for establishing realistic postoperative patient expectations, common analgesic care pathways, and standardized pill counts stratified by procedure type.

Opioid Prescribing Patterns of Foot and Ankle Surgeons: Single State Review.

The United States is currently in an opioid crisis. In order improve the amount of misuse and overdoses from opioids, some institutions have begun to create protocols based off of state and federal opioid prescription regulations. Our purpose is to analyze the current opioid prescribing patterns in foot and ankle surgery and create an institutional protocol. A survey on current opioid prescribing patterns based on the podiatric surgery was sent out from November 20, 2020 to January 11, 2021 to all members of the North Carolina Foot and Ankle Society. One-hundred surgeons participated in the survey. The most commonly prescribed postoperative pain medication was Hydrocodone/acetaminophen 5 mg/325 mg and the most common quantity was between 21 and 30 tablets. The most common medication for local blocks reported was bupivacaine and lidocaine mixed performed as a block closest to the surgical site. We recommend creating an institutional based opioid protocol for foot and ankle surgeries based off of the procedure performed by the surgeon. We recommend limiting prescriptions to under 30 tablets and utilizing a local or regional pain block for podiatric surgeries.