title: Zolpidem reduces postoperative pain, fatigue, and narcotic consumption following knee arthroscopy: a prospective randomized placebo-controlled double-blinded study.
abstract: Sixty-eight patients undergoing outpatient knee arthroscopy for treatment of meniscal tears or loose bodies were divided into three treatment groups (zolpidem [24 patients], control [24 patients], and placebo [20 patients]). All groups received postoperative hydrocodone and ibuprofen. Patients in the zolpidem group received a single dose of zolpidem tartrate for the first seven postoperative nights. Patients in the placebo group received a gelatin capsule similar in appearance to zolpidem and patients in the control group received only hydrocodone and ibuprofen. Patients in the control group demonstrated significantly worse mean daily postoperative pain and more daily postoperative fatigue on visual analog scales when compared with the zolpidem group (P=.03 and P=.04, respectively). Patients in the placebo group had worse daily postoperative pain and more daily postoperative fatigue when compared to the zolpidem group, although these differences did not reach statistical significance (P=.15, power=0.6; and P=.27, power=0.48, respectively). Patients in the control group consumed significantly higher quantities of hydrocodone/acetaminophen postoperatively (P=.04) than patients in the zolpidem group. Finally, patients in the placebo group consumed higher quantities of hydrocodone/acetaminophen than the zolpidem group although the difference did not reach statistical significance (P=.4; power=0.15). Power was calculated for each insignificant relationship based on observed effect and sample sizes and variances. This study demonstrates that sleep and fatigue may be an important factor in the effective pain management following knee arthroscopy. Future postoperative treatment regimens should address sleep and fatigue to maximize analgesic effects in these patients.
authors.affiliation: Department of Orthopedic Surgery, Brown Medical School, Providence, RI, USA.
authors.forename: Robert Z
authors.initials: RZ
authors.lastname: Tashjian
authors.forename: Rahul
authors.initials: R
authors.lastname: Banerjee
authors.forename: Michael P
authors.initials: MP
authors.lastname: Bradley
authors.forename: Winslow
authors.initials: W
authors.lastname: Alford
authors.forename: Paul D
authors.initials: PD
authors.lastname: Fadale
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D001182:Arthroscopy; D004311:Double-Blind Method; D004338:Drug Combinations; D005221:Fatigue / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage*; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007594:Joint Loose Bodies / Q000601:surgery*; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011184:Postoperative Period; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use*; D000070600:Tibial Meniscus Injuries; D000077334:Zolpidem
chemical_list: D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D009294:Narcotics; D011725:Pyridines; D000082:Acetaminophen; D006853:Hydrocodone; D000077334:Zolpidem