Additional Factors in Evaluating Opioid Use following Arthroscopic Knee Surgery

I read with great interest the article of Glogovac et al in a recent issue of Journal of Knee Surgery.[1] The authors performed a prospective study on 50 consecutive patients undergoing arthroscopic knee surgery and concluded that the main factors associated with higher postoperative opioid consumption included a major surgical procedure, receiving a regional anesthesia block, and higher area deprivation index score. The authors should be applauded for performing a well-designed study in an important topic (e.g., acute pain) in patients undergoing knee surgery.[2] [3] The need to tailor-specific preventive analgesic strategies to patients who will benefit the most is a very relevant topic in perioperative medicine.[4] [5]

Although the study of Glogovac et al was well conducted, there are critical points that need to be discussed by the authors to determine the validity of their findings. First, the authors did not describe in detail the use of postoperative nonopioid analgesics as this can substantially modify the use of postoperative opioids.[6] Second, the authors presented relatively few outcome events for the number of variables evaluated in their multivariate analysis, which may result in overfitting of their statistical model and substantially alter their conclusions. Finally, it would be very meaningful to provide confidence intervals of the authors' estimates given the small sample size of the study.

I would welcome comments as this would further support the findings of this important clinical trial.

Publication History

Received: 12 December 2018

Accepted: 07 January 2020

Article published online:
17 March 2020

• References

• 1 Glogovac G, Kennedy M, Parman MD, Bowers KA, Colosimo AJ, Grawe BM. Opioid requirement following arthroscopic knee surgery: are there predictive factors associated with long-term use. J Knee Surg 2021; 34 (08) 810-815
• 2 Wang AZ, Fan K. Ultrasound-guided posterior ramus of spinal nerve block for anesthesia and analgesia in lumbar spinal surgery. J Clin Anesth 2019; 52: 48-49
• 3 Schneider J, Broome B, Keeley D. Narcotic-free perioperative total knee arthroplasty: does the periarticular injection medication make a difference?. J Knee Surg 2021; 34 (04) 460-463
• 4 Koning MV, Veerkamp RAM. Dual epidural catheters for acute pain management of a patient with rib and tibial plateau fractures. J Clin Anesth 2019; 52: 53-54
• 5 Calandese F, Adduci A. Erector spinae plane block for acute postoperative pain management after anterior thoracolumbar spine surgery. J Clin Anesth 2019; 52: 55-56
• 6 Fanelli DG, Vu TN. Peri- and postoperative pain management in multiple ligament knee surgery in the hospital and ambulatory surgery center setting. J Knee Surg 2020; 33 (04) 320-327