quantify the amount of opioids used following ACL reconstruction, meniscal procedures, as well as labor repair of the hip and shoulder. Additionally, we wanted to describe the allocation of pain medications that go unused following these procedures. It's our hypothesis that patients are prescribed substantially more opioids than are needed, and based on recent events and reports, we hypothesize that younger patients of high school and college age would utilize more opioids and be more likely to dispose of their unused opioids in a non-FDA-recommended way. Patients undergoing these procedures were prospectively enrolled. They were excluded if they had an active workers' compensation claim or if they had a substantial past or recent history of opioid usage. All cases were done under general anesthesia with local or regional anesthesia based on surgeon preference, as well as recommendations from the anesthesiologist. The shoulders received interscalene blocks. There were multiple different blocks for ACLs, with the most common being the adductor canal block. And then opioid prescriptions were prescribed based on the surgeon preference. Patients were asked to record their daily opioid usage for the first two weeks postoperatively, and then in the third postoperative week, patients were surveyed to ask what their plans were for handling of the unused opioids. In total, there were 185 patients included in the study. When looking at opioid consumption, you'll see that this peaked for all procedures on days one and two postoperatively. Importantly, 71% of all the opioids consumed in the study period came in the first three days. And by day four, 63% of all patients had discontinued their opioid use. When you compare this to the initial prescription, you'll see that on average for all procedures, only 39% of the prescription was actually utilized. And looking at this in a different way, that means that over 60% went unused. And so our next question was, what's the ultimate destination of these unused opioids? And when surveyed in the third postoperative week, 25% of patients reported that they planned to save these unused opioids for future use. And this came despite having received FDA-guided recommendations for proper disposal at the beginning of the study. With regards to our age-related hypothesis, it was completely opposite of what we expected. The younger patients of high school and college age consumed significantly fewer opioids. And while not significant, a higher proportion expressed their intent to dispose of the unused opioids in a more responsible way. There's definite limitations to this observational study that looks at opioid usage that doesn't verify this usage through PDMP or pill counting. Another limitation is that there were 10 different surgeons included in the study across four different surgical centers. This thus brings a lot of variation with surgical techniques, prescribing patterns, as well as regional anesthesia techniques across the different centers. Despite these limitations, the overall message remains the same in that the majority of opioids prescribed following these procedures went unused, leaving an average of 11 5-milligram oxycodone pills remaining after every case. Most importantly, nearly 75% of the opioids were consumed in the first three days, which I think highlights the acute pain period as the critical time point that we need to continue to work on and address as we try to minimize our opioid usage and even progress to opioid-free arthroscopic surgery. Lastly, based on this study, we've been able to make some procedure-specific opioid recommendations as part of a larger multimodal perioperative pain regimen. Thank you.

opioids

ACL reconstruction

meniscal procedures

hip repair

shoulder repair