Multimodal Pain Strategies Effectively Reduce Opioid Use
Over the last 10 years, opioid use among patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) decreased as multimodal approaches to pain management increased, according to the findings of a recent study.
For their study, the researchers identified 377,657 patients who underwent THA and 779,338 patients who underwent TKA from 2006 through 2014 using the Premier Perspective database, which included 546 hospitals. They collected data on use of opioids, peripheral nerve block (PNB), intravenous acetaminophen, gabapentin/pregabalin, nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, and ketamine.
Patients were categorized into 4 groups based on whether they only received opioids or received opioids with 1, 2, or more than 2 analgesic therapies. The researchers analyzed annual utilization trends and hospital characteristics associated with opioid or multimodal use for THA and TAK separately.
Non-Opioid Recommendations For Pain Management in CKD Patients
Opioid Use Decreases With Electrotherapy, Acupuncture After Knee Replacement
Overall, 17.6% of patients who underwent THA did not receive multimodal postoperative pain management, with 37.2% (n=140,622), 29% (n=109,640), and 16.1% (60,911) of patients receiving opioids with 1, 2, and 3 additional analgesic therapies, respectively. Among TKA patients, 13.9% (n=108,622) of patients received opioids only, with 35.9% (n=279,777), 30.7% (n=239,158), and 19.5% (n=151,781) of patients receiving opioids with 1, 2, and 3 additional analgesic therapies, respectively.
Multimodal pain management appeared to be used slightly more often by small and medium-sized hospitals, with similar patterns observed for both patients undergoing THA and TKA.
Additionally, the researchers found sharp decreases in the percentage of THA not receiving multimodal pain management (from 27.7% in 2006 to 10.1% in 2014) and sharp increases in the percentage of patients receiving multimodal pain management. This coincided with a decrease in opioid use among THA patients, which was measured in morphine equivalents, from 304 in 2006 to 220 in 2014. They found similar patterns among TKA patients.
“In the last 10 years, opioid use for post-operative pain has declined in patients undergoing TKA and THA, as patients are increasingly being treated with a multimodal approach to pain control. This is especially true in small and medium sized hospitals, compared to larger hospitals,” the researchers concluded. “With increasing emphasis on limiting opioid use, this change displays alternate possibilities for successfully treating post-operative pain.”
Gerner P, Poeran J, Cozowicz C, et al. Multimodal pain management in total hip and knee arthroplasty: trends over the last 10 years. Presented at: American Society of Anesthesiology Annual Meeting; October 21-25, 2017; Boston, MA. Abstract A1069.