Inpatient and outpatient opioid requirements after total joint replacement are strongly influenced by patient and surgical factors
| Autor: | Maria A. Munsch, Joshua S. Everhart, Austin J. Roebke, Garrhett G. Via, Kanu S. Goyal, Mengnai Li, Andrew H. Glassman |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
musculoskeletal diseases
General Orthopaedics total knee arthroplasty medicine.medical_specialty total hip arthroplasty Analgesic Total knee arthroplasty total joint replacement 03 medical and health sciences 0302 clinical medicine postoperative opioid requirements Medicine multimodal analgesia Total joint replacement 030212 general & internal medicine spinal anesthesia 030222 orthopedics business.industry General Engineering Spinal anesthesia total joint arthroplasty National guideline Opioid postoperative pain control Regional anesthesia opioid Physical therapy regional anesthesia business Total hip arthroplasty medicine.drug |
| Zdroj: | Bone & Joint Open |
| ISSN: | 2633-1462 |
| Popis: | Aims Currently, there is no single, comprehensive national guideline for analgesic strategies for total joint replacement. We compared inpatient and outpatient opioid requirements following total hip arthroplasty (THA) versus total knee arthroplasty (TKA) in order to determine risk factors for increased inpatient and outpatient opioid requirements following total hip or knee arthroplasty. Methods Outcomes after 92 primary total knee (n = 49) and hip (n = 43) arthroplasties were analyzed. Patients with repeat surgery within 90 days were excluded. Opioid use was recorded while inpatient and 90 days postoperatively. Outcomes included total opioid use, refills, use beyond 90 days, and unplanned clinical encounters for uncontrolled pain. Multivariate modelling determined the effect of surgery, regional nerve block (RNB) or neuraxial anesthesia (NA), and non-opioid medications after adjusting for demographics, ength of stay, and baseline opioid use. Results TKAs had higher daily inpatient opioid use than THAs (in 5 mg oxycodone pill equivalents: median 12.0 vs 7.0; p < 0.001), and greater 90 day use (median 224.0 vs 100.5; p < 0.001). Opioid refills were more likely in TKA (84% vs 33%; p < 0.001). Patient who underwent TKA had higher independent risk of opioid use beyond 90 days than THA (adjusted OR 7.64; 95% SE 1.23 to 47.5; p = 0.01). Inpatient opioid use 24 hours before discharge was the strongest independent predictor of 90-day opioid use (p < 0.001). Surgical procedure, demographics, and baseline opioid use have greater influence on in/outpatient opioid demand than RNB, NA, or non-opioid analgesics. Conclusion Opioid use following TKA and THA is most strongly predicted by surgical and patient factors. TKA was associated with higher postoperative opioid requirements than THA. RNB and NA did not diminish total inpatient or 90-day postoperative opioid consumption. The use of acetaminophen, gabapentin, or NSAIDs did not significantly alter inpatient opioid requirements. Cite this article: Bone Joint Open 2020;1-7:398–404. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|