Are Narcotic Analgesics Necessary After Soft Tissue Tumor Excision? The Role of Meloxicam in Orthopaedic Oncology Surgery

Introduction: Efforts have been made within the medical community to limit the prescription of these opioids, and surgeons have looked towards alternative approaches to control postoperative pain. Meloxicam, a nonsteroidal anti-inflammatory drug (NSAID), may serve as a replacement for, or supplement to, opioids in this setting. This study investigates patient preferences related to these analgesics and evaluates whether meloxicam can serve as an alternative to opioids for patients undergoing ambulatory soft tissue tumor excision. Methods: 28 patients who underwent resection of a benign soft tissue tumor were given prescriptions for oxycodone and meloxicam, with instructions to fill and consume the prescriptions “based on their comfort level.” Each patient completed a daily pain journal postoperatively to record pain fluctuations and pill consumption. Statistical analysis was conducted using a Wilcoxon Rank Sum test for the pain level calculations, as well as the subset analyses of tumor size, depth and location. Fisher Exact tests were used in comparing demographic, clinical, and medication-related data between the two groups. Results: Less than 50% of patients filled the oxycodone prescription, while all patients filled meloxicam. An even smaller percentage of those patients who filled the narcotic prescription, actually consumed oxycodone. A greater proportion of patients with large tumors (>5cm) consumed narcotics. The two groups experienced equivalent levels of average pain, though a trend did exist patients with large tumors and those who underwent upper extremity surgery experienced higher VAS scores. Conclusion: This pilot study serves as proof-of-concept regarding the operation of a prospective trial of various analgesic strategies in orthopedic oncology. Non-inferiority of meloxicam as an effective analgesic for patients undergoing soft tissue tumor excision is suggested by our results, which support the role that non-narcotic analgesics should play in achieving adequate post-operative pain control in ambulatory soft tissue tumor excision.