Reducing Postoperative Opioid Use in Orthopaedics: A Review of Multimodal Analgesia Strategies, Patient Outcomes, and Implementation into Practice

The opioid crisis has underscored the urgent need for safer, more effective postoperative pain management strategies in orthopaedic surgery. Traditionally, opioids have played a central role in post-surgical analgesia. Still, emerging evidence supports the use of multimodal analgesia (MMA) protocols to reduce and possibly eliminate opioid dependence while maintaining effective pain control. This review focuses exclusively on opioid-sparing strategies in orthopaedic procedures, drawing from randomized controlled trials, retrospective case series, and meta-analyses. Across upper extremity surgery, joint arthroplasty, and ambulatory procedures, MMA has consistently demonstrated reduced opioid consumption, equivalent or improved pain scores, and enhanced functional recovery. Integration with Enhanced Recovery After Surgery (ERAS) pathways has further standardized MMA as best practice. With proper implementation, routine opioid use in postoperative orthopaedic care can be minimized, mitigating risks of chronic use, including dependence, among other adverse effects. This review suggests that opioid-sparing protocols should be the standard of care in orthopaedics, with opioids serving only as a rescue medication for breakthrough pain when absolutely necessary.