The use of a non-benzodiazepine hypnotic sleep-aid (Zolpidem) in patients undergoing ACL reconstruction: a randomized controlled clinical trial.
OBJECTIVE
Previous studies have addressed post-operative pain management after ACL reconstruction by examining the use of intra-articular analgesia and/or modification of anesthesia techniques. To our knowledge, however, no previous studies have evaluated the effect of zolpidem on post-operative narcotic requirements, pain, and fatigue in patients undergoing outpatient arthroscopic ACL reconstruction. The purpose of this prospective, blinded, randomized, controlled clinical study was to evaluate the effect of zolpidem on post-operative narcotic requirements, pain, and fatigue in patients undergoing outpatient arthroscopic ACL reconstruction.


METHODS
Twenty-nine patients undergoing arthroscopic ACL reconstruction were randomized to a treatment group or placebo group. Both groups received post-operative hydrocodone/acetaminophen bitartrate (Vicodin ES). Patients in the treatment group received a single dose of zolpidem for the first seven post-operative nights. Patients in the placebo group received a gelatin capsule similar in appearance to zolpidem. The amount of Vicodin used in each group, the amount of post-operative pain, and the amount of post-operative fatigue were analyzed.


RESULTS
Following ACL reconstruction, a 28% reduction was seen in the total amount of narcotic consumed with zolpidem (P = 0.047) when compared to placebo. There were no significant differences in post-operative pain or fatigue levels between zolpidem and placebo.


CONCLUSIONS
Adding zolpidem to the post-operative medication regimen after arthroscopic ACL reconstruction helps to lower the amount of narcotic pain medication required for adequate analgesia.


METHODS
Randomized controlled clinical trial, Level I.
Department of Orthopaedics, Alpert Brown Medical School/Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA. tompkinsm@hotmail.com
Marc
M
Tompkins
Matthew
M
Plante
Keith
K
Monchik
Braden
B
Fleming
Paul
P
Fadale
D000082:Acetaminophen / Q000008:administration & dosage*; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000704:Analysis of Variance; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001182:Arthroscopy; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage*; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007052:Ibuprofen / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010919:Placebos; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use*; D019651:Plastic Surgery Procedures; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D000077334:Zolpidem
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D010919:Placebos; D011725:Pyridines; C083640:acetaminophen, hydrocodone drug combination; D000082:Acetaminophen; D006853:Hydrocodone; D000077334:Zolpidem; D007052:Ibuprofen
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