New Pain Protocol Eliminates Opioid Use in Majority of Knee Replacement Patients

Number of Patients with at Least One Initial and Refill Opioid Prescription During the First 3 Months After TKA. Dark gray indicates patients whose opioids were prescribed by a member of the orthopedic team and light gray indicates patients whose opioids were prescribed another provider. Credit: Journal of Experimental Orthopaedics (2023). DOI: 10.1186/s40634-023-00585-0

A recent study conducted by a team of researchers led by Dr. Vinod Dasa, a Professor of Orthopaedics at LSU Health New Orleans School of Medicine, has found a novel pain management strategy that provides pain relief for patients who have undergone total knee arthroplasty (TKA), or total knee replacement, without the need for opioids. The research also revealed that changing opioid prescriptions at discharge from automatic to upon request has dramatically decreased opioid use. The findings have been published in the Journal of Experimental Orthopaedics.

Multimodal Analgesia Protocol

The study involved 144 patients who received the same multimodal analgesia protocol except for postoperative opioid prescribing. The novel multimodal analgesia regimen included percutaneous cryo-neurolysis, a long-acting nerve block, administered approximately five days before surgery. Before the surgery, patients were given a single dose of 150 mg pregabalin, 200 mg celecoxib, and 1000 mg intravenous (IV) acetaminophen. After the operation, patients were advised to take 325 mg of acetaminophen every four hours for two weeks and 75 mg of diclofenac every 12 hours for six weeks.

Effective Pain Management

The results showed that the majority of opioid-naïve patients only needed Tylenol and anti-inflammatory medications to manage their pain. In fact, approximately 70% of patients were able to recover from TKA without the use of any opioids and any worsening of self-reported pain or knee-related problems compared with patients who received an opioid prescription automatically upon discharge.

Dr. Dasa noted that "Opioid use in health care is improving but remains difficult to manage. Surgical pain was long thought to be unavoidable, requiring a large amount of pain medications. Creating innovative strategies to enhance surgical recovery by reducing pain and eliminating opioids can help solve some of our biggest challenges."

Journal Information: Leland van Deventer et al, A modern multimodal pain protocol eliminates the need for opioids for most patients following total knee arthroplasty: results from a retrospective comparative cohort study, Journal of Experimental Orthopaedics (2023). DOI: 10.1186/s40634-023-00585-0