Evidence map›Paper›PMID 36265899›Full record

ArticleCanadian journal of surgery. Journal canadien de chirurgie

Reduction of opioid use after orthopedic surgery: a scoping review.

Jessica Gormley, Kyle Gouveia, Seaher Sakha, Veronica Stewart, Ushwin Emmanuel, Michael Shehata, Daniel Tushinski, Harsha Shanthanna, Kim Madden

Abstract readScoping Review
PubMed Full text at PMC Publisher
In one paragraph

Article in Canadian journal of surgery. Journal canadien de chirurgie. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed.

  1. Patients Experiencing Homelessness Have Higher Complication Rates After Total Shoulder Arthroplasty.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026
    Article
  2. Article
  3. Article
  4. Review
  5. Persistent Opioid Use Following Major Orthopedic Surgery.Current pain and headache reports · 2025
    Review
  6. Article
  7. Article
  8. Article
  9. Review
  10. Review
  11. Article
  12. Review
  13. Article
  14. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Jessica GormleyFrom the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden).
Kyle GouveiaFrom the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden).
Seaher SakhaFrom the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden).
Veronica StewartFrom the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden).
Ushwin EmmanuelFrom the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden).
Michael ShehataFrom the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden).
Daniel TushinskiFrom the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden).
Harsha ShanthannaFrom the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden).
Kim MaddenFrom the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden) maddenk@mcmaster.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe opioid epidemic is one of the biggest public health crises of our time, and overprescribing of opioids after surgery has the potential to lead to long-term use. The purpose of this review was to identify and summarize the available evidence on interventions aimed at reducing opioid use after orthopedic surgery.

methodsWe searched CENTRAL, Embase and Medline from inception until August 2019 for studies comparing interventions aimed at reducing opioid use after orthopedic surgery to a control group. We recorded demographic data and data on intervention success, and recorded or calculated percent opioid reduction compared to control.

resultsWe included 141 studies (20 963 patients) in the review, of which 113 (80.1%) were randomized controlled trials (RCTs), 6 (4.3%) were prospective cohort studies, 16 (11.4%) were retrospective cohort studies, 5 (3.6%) were case reports, and 1 (0.7%) was a case series. The majority of studies (95 [67.4%]) had a follow-up duration of 2 days or less. Interventions included the use of local anesthetics and/or nerve blocks (42 studies [29.8%]), nonsteroidal anti-inflammatory drugs (31 [22.0%]), neuropathic pain medications (9 [6.4%]) and multimodal analgesic combinations (25 [17.7%]. In 127 studies (90.1%), a significant decrease in postoperative opioid consumption compared to the control intervention was reported; the median opioid reduction in these studies was 39.7% (range 5%-100%). Despite these reductions in opioid use, the effect on pain scores and on incidence of adverse effects was inconsistent.

conclusionThere is a large body of evidence from randomized trials showing the promise of a variety of interventions for reducing opioid use after orthopedic surgery. Rigorously designed RCTs are needed to determine the ideal interventions or combination of interventions for reducing opioid use, for the good of patients, medicine and society.

Indexed as

Opioid-Related DisordersOrthopedic ProceduresAnalgesicsAnalgesics, OpioidAnesthetics, LocalAnti-Inflammatory Agents, Non-SteroidalHumansPostoperative PainRandomized Controlled Trials as TopicAnalgesicsAnalgesics, OpioidAnesthetics, LocalAnti-Inflammatory Agents, Non-Steroidal

Identifiers

PMID36265899
PMCPMC9592092

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.