Opioid Use Consequences, Governmental Strategies, and Alternative Pain Control Techniques Following Total Hip Arthroplasties

Abstract

Over the last several decades, rates of opioid use and associated problems have dramatically increased in the United States leading to laws limiting prescription duration for acute pain management. As a result, orthopedic surgeons who perform total hip arthroplasty (THA), a procedure that often leads to significant postoperative pain, have been faced with substantial challenges to adequately mitigate patient pain while also reducing opioid intake. Current strategies include identifying and correcting modifiable risk factors associated with postoperative opioid use such as preoperative opioid use, alcohol and tobacco abuse, and untreated psychiatric illness. Additionally, recent evidence has emerged in the form of Enhanced Recovery After Surgery (ERAS) protocols suggesting that a multidisciplinary focus on patient factors perioperatively can lead to reduced postoperative opioid administration and decreased hospital stays. A cornerstone of ERAS protocols includes multimodal pain regimens with opioid rescue only as needed, which often includes multiple systemic pain therapies such as acetaminophen, gabapentin, non-steroidal anti-inflammatory drugs, as well as targeted pain therapies that include epidural catheters and ultrasound-guided nerve blocks. Many hospital systems and states have also implemented opioid prescribing limitations with mixed success. As the opioid epidemic continues in the United States, while contributing to poor outcomes following elective surgeries, further research is warranted to identify multidisciplinary strategies that mitigate opioid use while also allowing for adequate pain control and rehabilitation.

Nowadays anesthesiologists "look up"

“…Ultrasound-guided regional anesthesia techniques have proven their effectiveness in achieving these goals: when combined with light sedation, regional anesthesia avoids postoperative cognitive impairment, 16 prevents the onset of chronic pain at the operation site, 17 and avoids opioid dependence in the postoperative period. 18 the work by Bjorn et al 19 presented in this issue of Minerva Anestesiologica seems to fit perfectly into the scientific evolution of regional anesthesia in orthopedics described above: it is a study on volunteers whose primary objective is to define the sensory efferents of the skin covering the patella; it obtains this information by highlighting with Us the peripheral branches of the saphenous and femoral cutaneous nerves and identifying the area of competence of each; it describes an innovative technique to block the anterior branch of the medial femoral cutaneous nerve; at the same time, has the secondary, but certainly more clinically relevant objective of indicating these techniques for the treatment and/or prevention of chronic neuropathic pain in the patellar region due to the initial skin cut, which affects approximately 10% of patients undergoing knee prosthetic surgery. in conclusion, the authors used the Us, proposed a new technique, and thought about long-term outcomes, such as the prevention of chronic pain.…”