Abstract
Introduction
Despite the widespread use of opioids for pain control in post-operative joint arthroplasty patients, data regarding actual opioid consumption in opioid-naive patients during the recovery period are limited. We sought to determine postoperative opioid consumption for opioid-naïve patients undergoing total knee and hip arthroplasty (THA and TKA) procedures.
Methods
The study cohort consisted of 55 patients (29 females, 26 males) who underwent either primary unilateral TKA (n=28) or THA (n=27). Prior to discharge, patients were provided with a medication log on which to track daily consumption of pain medicine. Patients were asked to provide details regarding the type of pain medication, quantity and frequency of use, and pain score at the time of use. Patients were contacted weekly by a member of the study team to monitor compliance. Specific opioid prescription information was acquired for each subject using their electronic medical record. Subjects returned the completed logs once they ceased opioid use post-operatively. Daily quantity was converted to daily Morphine Equivalent Dose (MED). Average daily, weekly, and total post-operative use was calculated for all opioid data variables. Descriptive statistics (mean, frequency, deviation) were used to analyze opioid data. All dependent variables were compared between TKA and THA patients using separate independent samples t-tests or Chi-square tests.
Results
Overall, patients undergoing joint arthroplasty procedures were prescribed an average of 66.8±44.6 opioid pills during the post-operative period, with higher prescribed amounts for TKA patients compared to THA patients (42.5±8.7 vs. 86.6±51.9; p=0.01). However, patients reported consuming only an average of 31.1±36.8 pills for a total of 214.1±259.5 MED during the post-operative period, with higher consumption for TKA versus THA patients (100.5±112.2 vs. 323.6±311.8;p=0.005). The median number of unused pills was 32 for TKA patients and 27.5 for THA patients. Patients reported an average pain score of 4.3 at the time of consumption and stated that pain relief lasted an average of 4.9 hours. TKA patients reported higher pain scores compared to THA patients (p=0.032). On average, patients ceased opioid usage at 14.5±7.5 days post-operatively, with no patients requiring opioids past 31 days post-surgery. There were 13 patients (8 THA, 5 TKA) who utilized only acetaminophen for pain control, stating that they did not require opioids for pain management.
Conclusion
Following total joint arthroplasty, patients consume an average of 31 opioid pills postoperatively, which is less than half of the average prescription quantity. Given the current opioid crisis in society, reducing the number of unused opioids is imperative. Our data show that opioid requirements for pain management following arthroplasty procedures are well below prescription rates. Our results can be used to help develop standardized opioid prescribing guidelines following joint replacement and help educate patients on proper pain control.
