Opioid-Free Analgesia Provides Pain Control Following Thumb Carpometacarpal Joint Arthroplasty

Update: This article was updated on July 22, 2024, because of a previous error. On page 1757, the Note that had read “The CORE Study Group includes Todd M. Chapman Jr., MD; Bruce E. Cohen, MD; Patrick M. Connor, MD; Brian M. Curtin, MD; W. Hodges Davis, MD; J. Kent Ellington, MD; James E. Fleischli, MD; Samuel E. Ford, MD; Todd A. Irwin, MD; Carroll P. Jones III, MD; R. Alden Milam IV, MD; Bryan M. Saltzman, MD; P. Bradley P. Segebarth; Shadley C. Schiffern, MD; and Scott B. Shawen, MD.” now reads “The CORE Study Group includes Todd M. Chapman Jr., MD; Bruce E. Cohen, MD; Patrick M. Connor, MD; Brian M. Curtin, MD; W. Hodges Davis, MD; J. Kent Ellington, MD; James E. Fleischli, MD; Samuel E. Ford, MD; Todd A. Irwin, MD; Carroll P. Jones III, MD; Daniel P. Leas, MD; R. Alden Milam IV, MD; Bryan M. Saltzman, MD; P. Bradley Segebarth, MD; Shadley C. Schiffern, MD; and Scott B. Shawen, MD.” An erratum has been published: J Bone Joint Surg Am. 2024 Sep 4;106(17):e39. Background: We hypothesized that an opioid-free (OF), multimodal pain management pathway for thumb carpometacarpal (CMC) joint arthroplasty would not have inferior pain control compared with that of a standard opioid-containing (OC) pathway. Methods: This was a single-center, randomized controlled clinical trial of patients undergoing primary thumb CMC joint arthroplasty. Patients were randomly allocated to either a completely OF analgesic pathway or a standard OC analgesic pathway. Patients in both cohorts received a preoperative brachial plexus block utilizing 30 mL of 0.5% ropivacaine that was administered via ultrasound guidance. The OF group was given a combination of cryotherapy, anti-inflammatory medications, acetaminophen, and gabapentin. The OC group was only given cryotherapy and opioid-containing medication for analgesia. Patient-reported pain was assessed with use of a 0 to 10 numeric rating scale at 24 hours, 2 weeks, and 6 weeks postoperatively. We compared the demographics, opioid-related side effects, patient satisfaction, and Veterans RAND 12-Item Health Survey (VR-12) results between these 2 groups. Results: At 24 hours postoperatively, pain scores in the OF group were statistically noninferior to, and lower than, those in the OC group (median, 2 versus 4; p = 0.008). Pain scores continued to differ significantly at 2 weeks postoperatively (median, 2 versus 4; p = 0.001) before becoming more similar at 6 weeks (p > 0.05). No difference was found between groups with respect to opioid-related side effects, patient satisfaction, or VR-12 results. Conclusions: A completely opioid-free perioperative protocol is effective for the treatment of pain following thumb CMC joint arthroplasty in properly selected patients. Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.