Revision Total Knee Arthroplasty Is Associated With Significantly Higher Opioid Consumption as Compared With Primary Total Knee Arthroplasty in the Acute Postoperative Period

Bernstein, Jenna A.; Feng, James E.; Mahure, Siddharth A.; Schwarzkopf, Ran; Long, William J.

doi:10.1016/j.artd.2020.04.001

Cited by 9 publications

(3 citation statements)

References 37 publications

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“…Despite advances in multimodal pain regimen and the use of regional anesthetic techniques, opioid consumption has been demonstrated to be higher in revision TKA as compared with primary TKA. 27 Pain control in those exposed chronic opioids preoperatively is more difficult to achieve. 28 Thus, at higher doses, the negative side effects of opioids, such as urinary retention, ileus, nausea, and vomiting, may become more apparent.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2023

J Knee Surg

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This is a retrospective study. Prior studies have characterized the deleterious effects of narcotic use in patients undergoing primary total knee arthroplasty (TKA). While there is an increasing revision arthroplasty burden, data on the effect of narcotic use in the revision surgery setting remain limited. Our aim was to characterize the effect of active narcotic use at the time of revision TKA on patient-reported outcome measures (PROMs). A total of 330 consecutive patients who underwent revision TKA and completed both pre-and postoperative PROMs was identified. Due to differences in baseline characteristics, 99 opioid users were matched to 198 nonusers using the nearest-neighbor propensity score matching. Pre-and postoperative knee disability and osteoarthritis outcome score physical function (KOOS-PS), patient reported outcomes measurement information system short form (PROMIS SF) physical, PROMIS SF mental, and physical SF 10A scores were evaluated. Opioid use was identified by the medication reconciliation on the day of surgery. Propensity score-matched opioid users had significantly lower preoperative PROMs than the nonuser for KOOS-PS (45.2 vs. 53.8, p < 0.01), PROMIS SF physical (37.2 vs. 42.5, p < 0.01), PROMIS SF mental (44.2 vs. 51.3, p < 0.01), and physical SF 10A (34.1 vs. 36.8, p < 0.01). Postoperatively, opioid-users demonstrated significantly lower scores across all PROMs: KOOS-PS (59.2 vs. 67.2, p < 0.001), PROMIS SF physical (43.2 vs. 52.4, p < 0.001), PROMIS SF mental (47.5 vs. 58.9, p < 0.001), and physical SF 10A (40.5 vs. 49.4, p < 0.001). Propensity score-matched opioid-users demonstrated a significantly smaller absolute increase in scores for PROMIS SF Physical (p ¼ 0.03) and Physical SF 10A (p < 0.01), as well as an increased hospital length of stay (p ¼ 0.04). Patients who are actively taking opioids at the time of revision TKA report significantly lower preoperative and postoperative outcome scores. These patients are more likely to have longer hospital stays. The apparent negative effect on patient reported outcomes after revision TKA provides clinically useful data for surgeons in engaging patients in a preoperative counseling regarding narcotic use prior to revision TKA to optimize outcomes.

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Section: Discussionmentioning

confidence: 99%

Untitled

2023

J Knee Surg

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“…Inadequate pain control postoperatively can result in delays in ambulation and physiotherapy and, hence, poor functional recovery and patient satisfaction. Additionally, it can prolong hospital stays and increase the risk of complications like deep vein thrombosis [1,2].…”

Section: Introductionmentioning

confidence: 99%

The Use of Erector Spinae Plane Block Reduces Opioid Consumption and Pain Score in Postoperative Period After Hip Surgery: A Meta-Analysis

Huda,

Ghafoor

2023

Cureus

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Erector spinae plane block (ESPB) is a relatively new regional anesthesia block that has been used in thoracic and abdominal surgeries with variable success. ESPB can easily be administered using an ultrasound technique with a safer profile. Recently, there have been few randomized controlled trials (RCTs) regarding the role of ESPB in hip surgeries. A current meta-analysis was done to evaluate the role of ESPB block in controlling postoperative pain after hip surgeries.PRISMA guidelines were followed to perform this meta-analysis. We used online databases including Science Direct, PubMed, Google Scholar, and Cochrane Library. This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database as ID-CRD42023445516 in July 2023. We included studies that reported opioid use, pain control after surgery, and side effects associated with ESPB for hip surgeries. The ReviewManager software, i.e., RevMan for Mac 5.4 (Cochrane Collaboration, Oxford, UK), was utilized to conduct this meta-analysis.We included five RCTs during this meta-analysis. Our results demonstrated that the use of ESPB in hip surgery caused a significant decrease in 24-hour postoperative opioid consumption (p=0.02). ESPB also resulted in a significant decrease in pain scores up to nine hours postoperatively (p<0.05).

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“…While the use of opioids remains a key component of postoperative pain management [ 3 , 4 ], in recent years, implementation of Enhanced Recovery After Surgery (ERAS) protocols to optimize patient outcomes have included strategies for decreasing postoperative pain via a multimodal, opioid-sparing approach [ 4 , 5 ]. However, many multimodal analgesic protocols under the ERAS guidelines have provided inconsistent evidence on postoperative opioid-sparing abilities or adequate pain control [ 4 , 6 , 7 ]. Recent studies also report increased adverse events (AEs) associated with the use of non-opioid strategies [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%