Author: Fran Lowry
Medscape Medical News
A large pre-post intervention study at the Pan Am Clinic in Winnipeg found that combining patient education with a multimodal analgesic protocol significantly reduced opioid use after outpatient orthopedic surgery. The strategy included scheduled acetaminophen and ibuprofen for five days, with tramadol prescribed only for breakthrough pain, and an educational pamphlet on opioid risks.
Among more than 10,000 opioid-naive patients undergoing outpatient knee or shoulder procedures, the protocol led to an 18% reduction in opioid dispensing and nearly halved the rate of chronic postoperative opioid use (from 4.8% to 2.6%). Patients who received the intervention were about half as likely to still be filling opioid prescriptions six months after surgery.
The findings echo earlier smaller trials, including a Canadian RCT and a Neer Award–winning U.S. study, that demonstrated the benefits of multimodal approaches and patient education in reducing postoperative opioid consumption. Experts noted that setting realistic expectations about pain is key, and that acetaminophen and NSAIDs can often adequately control discomfort with far fewer side effects than opioids.
What You Should Know
• A multimodal, opioid-sparing strategy reduced opioid dispensing by 18% in outpatient orthopedic patients.
• Chronic postoperative opioid use fell by nearly 44% under the new protocol.
• Patient education on the normalcy of postoperative pain and safe analgesic strategies was central to success.
• Surgeons account for over half of new opioid prescriptions, making this intervention highly relevant to surgical practice.
Practice Implication
Surgeons and anesthesiologists should consider structured multimodal analgesia protocols and patient education to reduce postoperative opioid use without compromising pain control. These results suggest scalable, population-level benefits in curbing unnecessary opioid exposure.
References
Lowry F. July 09, 2025.
Thank you Canadian Journal of Surgery for allowing us to use this article.