Can intraoperative opioid use in hip and knee arthroplasty be reduced further without negatively affecting pain control: A case controlled study

TL;DR

This study shows that reducing intraoperative opioid use during hip and knee surgery does not worsen pain control or recovery outcomes.

Contribution

Demonstrates further opioid reduction is feasible without compromising postoperative pain or recovery in joint replacement surgery.

Findings

Study group received significantly lower intraoperative opioid doses (24.18 mg vs. 69.58 mg Morphine).

No significant increase in postoperative analgesia requirements or PONV in the reduced opioid group.

Lower opioid use did not hinder early postoperative mobility or recovery protocols.

Abstract

Whilst forming the backbone of perioperative analgesic regimes in joint replacement surgery, the negative side effect profile of opioids is well known. Common impediments to a smooth running Enhanced Rapid Recovery model of care are often altered cognitive function and postoperative nausea and vomiting (PONV), both related to opioid use.

This study focuses on evaluating whether further reductions in intraoperative opioid use during joint arthroplasty can be safely achieved with minimal impact of such reductions on pain control and postoperative outcomes including opioid requirements and the incidence of PONV and ability to mobilise.

Case controlled review of prospectively collected data assessing intraoperative opioid use, postoperative analgesic requirement, incidence of PONV and cognitive status as well as day 0 mobility postoperatively. 50 patients were randomized in the study and control groups.

The study group received statistically significant lower dose of intraoperative opioids equivalent to 24.18 mg of Morphine compared to control group with equivalent to 69.58 mg of Morphine (p < 0.001). There was no statistically significant increase in analgesia requirement postoperatively and no negative influence on PONV or ability to follow immediate postoperative rehabilitative protocols.

Opioid use intraoperatively can be reduced even further without any compromise of postoperative pain control and PONV and may further reduce impediments to efficiency in rapid recovery models of care.

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