Tag Archives: postoperative pain management

Chronic Prescription Opioid Use Before and After Total Joint Arthroplasty: Overall Promising News

Knee injuriesDr. Stickney, a Kirkland orthopedic surgeon, is an expert in total knee arthroplasty, total hip arthroplasty, exercise and health, and more.

An April 2019 study in the Journal of Arthroplasty explored the chronic prescription opioid use of patients under the age of 65 before and after having total knee arthroplasty or total hip arthroplasty. Looking at three years of MarketScan data between 2009 and 2012, patient opioid use was measured three months before and 12 months after their respective surgeries. With a large sample of more than 125,000 patients, a multicenter scope, and inclusion of both TKA and THA patients, the study lays out a strong and promising snapshot.

The goal of total joint arthroplasty is to reduce or eliminate the painful symptoms of a degenerative joint disease. Due to the addictive property of opioid medications, some patients may develop a pattern of chronic use after surgery. Others can develop chronic opioid use in managing their pain prior to surgery. “Chronic” was defined in the analysis as having two or more opioid prescriptions filled within a six-week period. 

Of the 24,127 patients (under 65) who were chronic opioid users before surgery, 72% were no longer chronic users 12 months post- op. Of the 100,892 patients under 65 who were nonusers before their surgeries, 4% became chronic opioid users one year post-op.  Patients under age 56 who had TKA or THA were 25% more likely to become chronic opioid users compared to those aged 56-65; and procedurally speaking, those undergoing TKA were 60% more likely to become chronic users than those undergoing THA. The length of hospital stay exceeding three days showed 32% higher odds associated with becoming a chronic opioid user. Being male or female did not significantly factor into the odds of chronic opioid use.

Patients who had TKA and hospital stays more than 3 days were significant risk factors of persisting chronic opioid use after surgery; age played a mixed use in predicting the change of opioid use.

With the authors’ definition of chronic opioid use in mind, the overall chronic opioid use decreased from 19% to 9% after total knee or total hip arthroplasty. Patients were more likely to cease chronic use after TJA (72%) than to become chronic users (4%).

My joint replacement patients seek options that reduce pain, reduce the need for narcotics and speed recovery more than ever. It’s common for patients with even the most debilitating arthritis to fear joint replacement, mostly dreading the pain of the surgery, complications around opioid use and fear or being out of commission after surgery. With the appropriate treatments, we can address your degenerative joint conditions while avoiding the pitfalls of chronic opioid use and on the path to an optimal recovery. If you have any questions about pain management before, during or after TKA or THA, please contact our office. We’ll help you return to your healthy, pain-free lifestyle.

Less Pain, Less Opioid Use After Total Knee Arthroplasty

Senior man on his mountain bike outdoorsDr. Stickney, a Kirkland orthopedic surgeon, is a knee expert specializing in new knee surgery procedures, total knee replacementsports medicine, and more.

Managing postsurgical pain after total knee arthroplasty (TKA) is critical to successful surgical outcomes including patient recovery, rehabilitation and overall satisfaction. Local infiltration analgesia (LIA) with anesthetic agents is shown to improve pain and reduce morphine consumption. It also shortens the length of hospital stays compared with using peripheral nerve blocks, which can hinder mobility. A randomized control PILLAR study conducted by Michael A. Mont, M.D., Walter B. Beaver, M.D., Stanley H. Dysart, M.D., John W. Barrington, M.D., and Daniel J. Gaizo, M.D. took a closer look at the efficacy of LIA with Liposomal Bupivacaine (LB) in improving patient pain scores and reducing opioid use after TKA.

Here, the study team compared the effects of LIA with or without LB on pain scores, opioid consumption including opioid-free patients, time to first opioid rescue, and safety after primary unilateral total knee arthroplasty.

The study involved 140 TKA patients randomized to LIA with LB to 266mg/20mL (admixed with bupivacaine HCI %0.5, 20mL) or LIA with Bupivacaine HCI %0.5, 20mL. Standardized infiltration techniques and standardized multimodal pain protocol were used. Co-primary efficacy endpoints were the area under the curve (AUC) visual analog scale pain intensity scores 12-48 hours post-surgery, and total opioid consumption 0-48 hours post-surgery.

Findings were notable. AUC 12-48 post-surgical visual analog pain intensity scores were 180.8 with LB, and 209.3 without the use of LB. Total opioid consumption 0-48 hours post-surgery was 18.7mg with and 84.9 without LB. Significant differences favoring LB were observed for the percentage of opioid-free patients (p<.01) and time to first opioid rescue (P=.0230).  In the TKA setting, LIA with LB administered with optimal techniques significantly improved post-surgical pain, opioid use and time to first opioid rescue, with more opioid free patients and no unexpected safety concerns.

My past TKA patients will tell you the SwiftPath protocols I utilize are well aligned to this study. With a reduction in (or no) opioids after TKA, less post-operative pain and overall patient satisfaction, the use of LIA with LB is well-supported.

If you are a total knee arthroplasty candidate and want to learn more about treatments such as LIA with LB, please contact our office. We’ll help you return to your healthy, pain-free lifestyle.