Prescribing and Consumption of Opioids After Primary, Unilateral Total Hip and Knee Arthroplasty in Opioid-Naive Patients

Roberts, Karl C.; Moser, Stephanie; Collins, Angela C.; McCardel, Brian R.; Schultz, Kyle A.; Schaffer, Nathaniel E.; Tramer, Joseph S.; Carpenter, Creg A.; Pierce, John G.; Edwards, Alan; Dubois, Kendall M.; Brummett, Chad M.

doi:10.1016/j.arth.2019.08.036

Cited by 30 publications

(22 citation statements)

References 26 publications

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“…They did not find an association between the number of opioids prescribed and the corresponding refill rate. However, they did identify an increase in consumption when a larger initial dose was prescribed [37].…”

Section: Discussionmentioning

confidence: 96%

Factors Associated with a Second Opioid Prescription Fill in Total Knee Arthroplasty

Wise

McCreary

Parikh

et al. 2020

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 96%

Factors Associated with a Second Opioid Prescription Fill in Total Knee Arthroplasty

Wise

McCreary

Parikh

et al. 2020

The Journal of Arthroplasty

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“…PP, per protocol; SOC, standard of care. while another study found that for every 1 pill prescribed, patients were likely to consume an additional~0.5 pill after total joint arthroplasty [17,18]. Further, standardized opioid prescription protocols have been previously shown to facilitate reduced opioid use [19].…”

Section: Discussionmentioning

confidence: 98%

Cryoneurolysis before Total Knee Arthroplasty in Patients With Severe Osteoarthritis for Reduction of Postoperative Pain and Opioid Use in a Single-Center Randomized Controlled Trial

Mihalko

Kerkhof

Ford

et al. 2021

The Journal of Arthroplasty

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Background: We hypothesized that preoperative cryoneurolysis of the superficial genicular nerves in patients with osteoarthritis would decrease postoperative opioid use relative to standard of care (SOC) treatment in patients undergoing total knee arthroplasty (TKA). Methods: Patients received either cryoneurolysis (intent-to-treat [ITT]: n ¼ 62) or SOC (ITT: n ¼ 62). The cryoneurolysis group received cryoneurolysis of the superficial genicular nerves 3e7 days before surgery plus a similar preoperative, intraoperative, and postoperative pain management protocol as the SOC group. The primary end point was cumulative opioid consumption in total daily morphine equivalents from discharge to the 6-week study follow-up assessment. Secondary end points included changes in pain and functional scores. Primary and secondary end points were assessed using ITT and per-protocol (PP) analyses. Results: The primary end point was not met in the ITT analysis (4.8 [cryoneurolysis] vs 6.1 [SOC] mg; P ¼ .0841) but was met in the PP analysis (4.2 vs 5.9 mg; P ¼ .0186) after excluding patients with medication deviations or missing follow-up data. Compared with the SOC group, the cryoneurolysis group had improved functional scores and numerical improvements in pain scores across all follow-up assessments, with significant improvements observed in current pain from baseline to the 72-hour and 2-week follow-up assessments and pain in the past week from baseline to the 12-week follow-up assessment. Conclusion: Findings from the PP analysis suggest that preoperative cryoneurolysis in patients with knee osteoarthritis can reduce opioid consumption and improve functional outcomes after TKA.

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“…Regarding unilateral hip and knee arthroplasty, a retrospective cohort study found that increased opioid prescription was associated with increased consumption and recommended a maximum of 50 tablets of 5-mg oxycodone after TKA and 30 tablets after THA. 13 Additionally, a prospective study of patients undergoing upper-extremity procedures found that soft-tissue procedures required fewer opioid medication than fracture-related procedures or joint procedures. 10 These findings can be used to more accurately tailor postoperative prescriptions in orthopedic surgery.…”

Section: Discussionmentioning

confidence: 99%

Opioid consumption following orthopedic shoulder surgery: a retrospective analysis

Vattigunta

Weiner

Nayar

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: Prescription opioid misuse has become an epidemic in the United States and is a leading cause of death in Americans. Postoperative opioid prescriptions are a significant contributor to the opioid epidemic, with orthopedic surgeons being the third highest prescribers of opioid prescriptions among physicians across all specialties. Our aim was to retrospectively evaluate overall opioid consumption patterns following surgical treatment for shoulder pathology and recommend evidence-based guidelines for standardized postoperative opioid prescriptions. Methods: We conducted a retrospective chart review of patients who underwent shoulder arthroscopy or arthroplasty from a single shoulder/elbow fellowship-trained surgeon (principal investigator). Patient and surgery characteristics were summarized for the entire sample and further stratified by surgery type. Total opioid consumption at the time of the first postoperative visit and refill patterns were compared between each surgery group. Opioid consumption was analyzed in morphine milligram equivalents (MMEs) and is reported in the equivalent number of 5-mg oxycodone tablets. Results: A total of 119 patients were included in our analysis. The average age was 58 AE 13 years, and 59% of patients were male. Rotator cuff repair was the most frequent surgery (n ¼ 52), followed by arthroplasty (n ¼ 35) and arthroscopy (n ¼ 28). On average, the patients in the study used 82.5 AE 233 MME units, equivalent to 11 AE 31.067 tablets of 5-mg oxycodone. Sixteen percent of patients did not use any opioids. There was no significant difference in opioid consumption or refills across surgery type. In the bivariate analysis for the entire sample, age was the only predictor that was statistically significantly associated with the amount of opioid consumption. In the multivariable model for patient demographics, significant predictors of opioid consumption were age, gender, and pain scores. In the multivariate analysis by surgery type, significant predictors of higher opioid consumption were age, gender, pain score, and surgery performed on the dominant side. Conclusion: On the basis of the consumption patterns observed in our patient cohort, we recommend prescribing 112.5 MME (15 tablets of 5-mg oxycodone) for arthroscopic shoulder procedures, and 75 MME (10 tablets of 5-mg oxycodone) for shoulder arthroplasties.

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Prescribing and Consumption of Opioids After Primary, Unilateral Total Hip and Knee Arthroplasty in Opioid-Naive Patients

Cited by 30 publications

References 26 publications

Factors Associated with a Second Opioid Prescription Fill in Total Knee Arthroplasty

Factors Associated with a Second Opioid Prescription Fill in Total Knee Arthroplasty

Cryoneurolysis before Total Knee Arthroplasty in Patients With Severe Osteoarthritis for Reduction of Postoperative Pain and Opioid Use in a Single-Center Randomized Controlled Trial

Opioid consumption following orthopedic shoulder surgery: a retrospective analysis

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