Perioperative Counseling Reduces Opioid Use After ACL Reconstruction Surgery

TUESDAY, July 29, 2025 (HealthDay News) — Opioid-limiting pain management education and counseling reduce opioid consumption with no increase in postoperative pain among patients undergoing anterior cruciate ligament (ACL) reconstruction surgery, according to a study published online July 16 in the Journal of Bone & Joint Surgery.

Jonathan D. Packer, M.D., from the University of Maryland School of Medicine in Baltimore, and colleagues evaluated the impact of opioid-limiting perioperative pain management education and counseling on postoperative opioid consumption in patients aged 14 years and older. The analysis included 121 participants randomly assigned (1:1) either to receive opioid-limiting perioperative pain management education with instructions to take opioids only as a last resort or traditional perioperative pain management with instructions to take opioids as needed for severe pain to “stay ahead of the pain” (control group).

The researchers found that within three months after surgery, patients assigned to the treatment group consumed a mean of 46.0 mg of total morphine equivalents (TMEs) versus 63.6 mg of TMEs in the control group. The average score on the Numeric Rating Scale for pain in the first 14 days was similar between the groups (2.5 in the treatment group versus 2.4 in the control group). There were no significant differences between the groups for refill of oxycodone prescriptions within three months after surgery (four patients in the treatment group and six patients in the control group). The two groups were similar for sleep quality and patient satisfaction.

“This study provides convincing evidence that we should abandon the practice of counseling patients to take opioids to “stay ahead of the pain” and counsel them to take them as a “last resort” to manage pain,” Packer said in a statement. “We believe that this approach is applicable to all surgeries, and we strongly recommend that clinicians consider adopting this simple strategy in their practice.”

Abstract/Full Text (subscription or payment may be required)