Authors: Woodmass J, et al.
Canadian Journal of Surgery. Published June 18, 2025.
This large pre-post intervention study evaluated the effect of an opioid-sparing protocol combining structured patient education with scheduled nonopioid analgesia (acetaminophen and ibuprofen), supplemented by tramadol for breakthrough pain, in outpatient orthopedic surgery patients. The analysis included over 10,000 opioid-naive patients undergoing knee or shoulder procedures at the Pan Am Clinic in Winnipeg.
Compared to the preintervention cohort (2013–2018), the postintervention cohort (2020–2022) demonstrated an 18% reduction in morphine milligram equivalents dispensed and a nearly 44% relative reduction in chronic opioid use at 6 months (from 4.8% to 2.6%). Patients receiving the protocol were almost half as likely to continue filling opioid prescriptions 181–270 days postoperatively.
The intervention hinged on setting patient expectations: patients were educated to expect some pain after surgery and to rely on acetaminophen and ibuprofen regularly for the first 5 days, reserving tramadol only for intolerable breakthrough pain. Surgeons also standardized prescribing practices, replacing prior variability with a consistent multimodal approach.
What You Should Know
• An opioid-sparing protocol reduced opioid prescribing volume by 18% in over 10,000 orthopedic surgery patients.
• Chronic opioid use at 6 months decreased by nearly half after implementation.
• Patient education and expectation management were central to protocol success.
• Nonopioid analgesics provided adequate control for most patients, with opioids reserved for severe breakthrough pain.
• Experts note the importance of future studies measuring patient-reported pain and recovery outcomes alongside prescribing metrics.
References
Woodmass J, et al. Can J Surg. 2025, 68.
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Bicket MC, Long JJ, Pronovost PJ, et al. JAMA Surg. 2017, 152:1106-1111. doi:10.1001/jamasurg.2017.0831
Chou R, Gordon DB, de Leon-Casasola OA, et al. J Pain. 2016, 17:131-157. doi:10.1016/j.jpain.2015.12.008
Thank you Canadian Journal of Surgery for allowing us to use this article.