In-hospital opioid use after hip and knee replacement surgeries decreased by one third between 2006 and 2014, according to a study presented here at Anesthesiology 2017 from the American Society of Anesthesiologists on October 21.
Researchers at the University of Massachusetts Medical School in Worcester analyzed data from more than 1.5 million hip and knee replacement surgeries performed at 546 hospitals and included in the national Premier Perspective database.
Among patients who underwent total hip arthroplasty (THA), 27.2% (7896 of 29,010) received opioids alone to manage pain in 2006 compared with only 10.1% (5311 of 52,208) in 2014. Similarly, among those patients undergoing total knee arthroplasty (TKA), 23.3% (14,418 of 61,888) received opioids alone to manage pain in 2006 compared with only 7.2% (7154 of 98,807) in 2014.
The researchers note than 1 million Americans have THA or TKA every year. “Most are prescribed opioids to manage pain as they recover, and about 30% develop chronic pain and continue to use opioids a long time after surgery.”
In addition to measuring the number of patients who received only opioids alone, the researchers looked at trends in the use of multimodal therapy. They defined the multimodal approach as opioids and one to three other pain management methods, including peripheral nerve block, acetaminophen, gabapentin/pregabalin, nonsteroidal anti-inflammatories, COX-2 inhibitors, or ketamine.
The researchers reported that in both types of surgeries, multimodal pain control increased dramatically during the study. Slightly more than half of patients with THA and TKA received multimodal care in 2006 (52.4% and 58.5%). By 2014, that number jumped to 92.5% and 97.7%, respectively.
“Not only has the number of opioids we are using in patients decreased substantially, we are also seeing a decrease in the number of patients using only opioids and a huge increase in [the proportion of] patients who are receiving multiple pain modalities,” lead author Philipp Gerner, a medical student at the University of Massachusetts Medical School, told Medscape Medical News.
Those findings mean providers are finding ways to reduce pain without opioids.
By Tinker Ready | Medscape
Image Credit: Tinker Ready/Medscape