Editorial Commentary: Postoperative Analgesia After Arthroscopy: A Step Toward the Personalization of Pain Control

Abstract

Identification of risk factors for prolonged opioid use is imperative as opioid misuse continues to plague society. Recent data suggest that many modifiable and nonmodifiable patient factors may be associated with prolonged opioid use after arthroscopic meniscal surgery. Surgeons and patients share the burden of the opioid epidemic and must collaborate to decrease the overall opioid burden on society. As the number of tools to treat pain and the knowledge of at-risk patients grow, standardized postoperative narcotic regimens to treat a diverse population of patients are no longer acceptable; narcotic regimens must be customized to each patient. To limit opioid use and enhance patient outcomes, it is apparent that the next frontier of postoperative pain control is upon us: the personalization of pain control.

Author Reply to “Published Multimodal Anesthetic Protocols Using Gabapentin Risk Substantial Side Effects and Are Not Recommended”

“…reviewed the selected hits (15 publications from 11 panel members) for relevance. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] To gain insight into the possible preferences for surgical approach, all publications of the panel members on the shoulder impingement subject, without time restriction, were also scored for this outcome. In cases of disagreement, assessment by a third reviewer (E.J.D.V.)…”

“…was decisive. Seven articles were considered relevant 7,[13][14][15]17,19,20 (and 8 were not [8][9][10][11][12]16,18,21 ). Of all articles related to shoulder impingement, 10 were scored as "in favor of surgery" [10][11][12][13][14][15][16][17]19,20 ; none, "not in favor of surgery"; and 5, "inconclusive."…”

“…Of all articles related to shoulder impingement, 10 were scored as "in favor of surgery" [10][11][12][13][14][15][16][17]19,20 ; none, "not in favor of surgery"; and 5, "inconclusive." [7][8][9]18,21 In contrast, of the 90 authors of systematic reviews (or studies included in these reviews) referred to in the consensus article, just 1 (G.A.) was selected for the panel.…”

“…We believe that this protocol should serve as a blueprint, and further work is required to optimize therapeutic effects while decreasing the side effect burden on a patient-to-patient basis. 18 Although the current regimen is found to be effective, continued research must evaluate whether alternative protocols are able to achieve a similar outcome. We would like to commend Dr. Siegel on his comments and the discussion of this important topic.…”