Early In-Hospital Pain Control Is a Stronger Predictor for Patients Requiring a Refill of Narcotic Pain Medication Compared to the Amount of Narcotics Given at Discharge

Wilke, Benjamin K.; Foster, Devon; Roberts, Christopher A.; Shi, Glenn G.; Lesser, Elizabeth R.; Heckman, Michael G.; Whalen, Joseph L.; Clendenen, Steven R.

doi:10.1016/j.arth.2019.02.059

Cited by 11 publications

(6 citation statements)

References 21 publications

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“…We agree with previous recommendations that tailoring of narcotic prescriptions is based on patient risk factors and narcotic requirements [1,9,46,47]. Patient and institutional education programs can effectively reduce opioid prescriptions [48,49]; however, a major concern with unused narcotics following arthroplasty would be the potential source available for abuse, diversion, or accidental ingestion and overdose in the community.…”

Section: Discussionsupporting

confidence: 82%

Use of Tetrahydrocannabinol and Cannabidiol Products in the Perioperative Period Around Primary Unilateral Total Hip and Knee Arthroplasty

Runner

Luu

Nassif

et al. 2020

The Journal of Arthroplasty

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Background: Given the opioid crisis in America, patients are trying alternative medications including tetrahydrocannabinol (THC) and other cannabidiol (CBD) containing products in the perioperative period, especially in states where these products are legal. This study sought to analyze usage rates of CBD/THC products in the perioperative period for primary unilateral total hip and knee arthroplasty (THA/TKA) patients and identify a possible association with post-operative opioid use. Methods: A prospective cohort of primary unilateral THA/TKA patients were enrolled at a single institution. Patients who completed detailed pain journals were retrospectively surveyed for CBD/THC product usage. Pain medications were converted to morphine milligram equivalents (MME). Results: Data from 195 of the 210 patients (92.9% response rate) following primary arthroplasty were analyzed. Overall, 16.4% of arthroplastyd22.6% (n ¼ 19) of TKA and 11.7% (n ¼ 13) of THAdpatients used CBD/THC products in the perioperative period. There was a wide variety of usage patterns among those using CBD/THC products. In comparing CBD/THC users and non-users, there was no significant difference in the length of narcotic use, total morphine milligram equivalents taken, narcotic pills taken, average post-op pain scores, the percentage of patients requiring a refill of narcotics, or length of stay. Conclusion: Understanding that CBD/THC usage was not consistent for patients who used these products, 22.6% of TKA and 11.7% of THA patients tried CBD/THC products in the perioperative period. In this small sample, CBD/THC use was not associated with a major effect on narcotic requirements. Further studies on the effects of CBD/THC are needed as these therapies become more widely available.

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Section: Discussionsupporting

confidence: 82%

Use of Tetrahydrocannabinol and Cannabidiol Products in the Perioperative Period Around Primary Unilateral Total Hip and Knee Arthroplasty

Runner

Luu

Nassif

et al. 2020

The Journal of Arthroplasty

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“…35,37 OTHER Other factors contributing to increased opioid use include specific characteristics of the surgery such as operative time and patient pain in the immediate postoperative period. 24,[42][43][44][45] Cao et al showed that longer operative times were independently associated with increased opioid use, which correlate with the previous findings of Polizer et al 24,43 Increased pain on post-operative day one and increased opioid utilization in the 24-hours before hospital discharge are also independent predictors of prolonged opioid use following TKA. 42,44,45…”

Section: Socioeconomic Factors and Medical Comorbiditiessupporting

confidence: 61%

“…24,[42][43][44][45] Cao et al showed that longer operative times were independently associated with increased opioid use, which correlate with the previous findings of Polizer et al 24,43 Increased pain on post-operative day one and increased opioid utilization in the 24-hours before hospital discharge are also independent predictors of prolonged opioid use following TKA. 42,44,45…”

Section: Socioeconomic Factors and Medical Comorbiditiessupporting

confidence: 61%

The Ramifications of Opioid Utilization and Outcomes of Alternative Pain Control Strategies for Total Knee Arthroplasties

et al. 2022

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Morbidity and mortality related to opioid use has generated a public health crisis in the United States. Total knee arthroplasty (TKA) is an increasingly common procedure and is often accompanied by post-operative opioid utilization. Unfortunately, post-operative opioid usage after TKA has been shown to lead to higher rates of complications, longer hospital stays, increased costs, and more frequent need for revision surgery. Pre-operative opioid utilization has been shown to be one of the most important predictors of post-operative opioid usage. Additional risk factors for continued post-operative opioid utilization after TKA include pre-operative substance and tobacco use as well as higher post-operative prescription dosages, younger age, female gender, and Medicaid insurance. One method for mitigating excessive post-operative opioid utilization are Enhanced Recovery After Surgery (ERAS) protocols, which include a multidisciplinary approach that focuses on perioperative factors to optimize patient recovery and function after surgery. Additional strategies include multimodal pain regimens with epidural anesthetics, extended duration local anesthetics and adjuvants, and ultrasound guided peripheral nerve blocks. In recent years, opioid prescribing duration limitations have also been put into place by state and federal government, hospital systems, and ambulatory surgery centers making effective acute pain management imperative for all stakeholders. In this regard, as rates of TKA continue to increase across the United States, multidisciplinary efforts by all stakeholders are needed to ensure adequate pain control while preventing the negative sequalae of opioid medications.

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“…In fact, postoperative pain was the only factor that predicted a high use of narcotics, independent of any demographic and surgical factor. Though a relatively obvious finding that has been reported in surgical fields before, 11,12 this perhaps points to a mental dependence based on whether patients felt that their pain was adequately controlled. Studies have looked at effective early pain control via other mechanisms to determine if it is enough to negate the need for a high use of narcotics.…”

Section: Discussionmentioning

confidence: 94%

Patterns in Pain and Opiate Use after Endoscopic Sinus Surgery

Ndon

Spock²,

Torabi

et al. 2020

Otolaryngol.--head neck surg.

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Objective To evaluate postoperative opiate use and patients’ opinions regarding pain management after endoscopic sinus surgery (ESS). Study Design Case series with planned data collection. Setting Tertiary referral medical center. Subjects and Methods We prospectively evaluated postoperative opiate utilization in adults undergoing ESS over a 2-year period at an academic medical facility. Exclusion criteria included use of nasal packing, intracranial or orbital procedures, tumor surgery, and any use of endoscopic drills. All patients underwent bilateral maxillary antrostomy, total ethmoidectomy, sphenoidotomy, and frontal sinusotomy with or without septoplasty. Patients were discharged with 30 oxycodone-acetaminophen (5-325 mg) and a survey assessing pain and narcotic/nonnarcotic use on postoperative days 0 to 7. Results A total of 64 patients completed surveys. Mean ± SD narcotic use over the 7-day postoperative period was 7.7 ± 7.6 pills. Patients with high narcotic use (>6 pills total) had no differences in demographic or surgical factors from those with low use (≤6 pills) but did report a higher level of postoperative day 1 pain (4.8 ± 1.1 vs 2.0 ± 1.4, P < .001). Narcotic use declined during this period, with <30% of patients requiring narcotics by postoperative day 3. Conclusion Our results support reduced opiate prescription and encouragement of nonnarcotic use after ESS without compromising effective pain management.

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Early In-Hospital Pain Control Is a Stronger Predictor for Patients Requiring a Refill of Narcotic Pain Medication Compared to the Amount of Narcotics Given at Discharge

Cited by 11 publications

References 21 publications

Use of Tetrahydrocannabinol and Cannabidiol Products in the Perioperative Period Around Primary Unilateral Total Hip and Knee Arthroplasty

Use of Tetrahydrocannabinol and Cannabidiol Products in the Perioperative Period Around Primary Unilateral Total Hip and Knee Arthroplasty

The Ramifications of Opioid Utilization and Outcomes of Alternative Pain Control Strategies for Total Knee Arthroplasties

Patterns in Pain and Opiate Use after Endoscopic Sinus Surgery

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