A Novel Opioid-Sparing Pain Management Protocol Following Total Hip Arthroplasty
Jonathan A. Gabor BS, Jorge A. Padilla MD, Ran Schwarzkopf MD, Roy Davidovitch MD
Opioid prescriptions and subsequent opioid-related deaths have increased substantially in the past several decades. Orthopedic surgery ranks among the highest of all specialties with respect to the amount of opioids prescribed. We present here the outcomes of our opioid-sparing pain management pilot protocol for total hip arthroplasty (THA).
A retrospective study was conducted to assess outcomes before and after the implementation of a novel opioid-sparing pain management protocol for THA. A total of 669 consecutive patients between April 2017 and June 2018 were divided into two cohorts for comparison: 1) Traditional pain management protocol, and 2) Opioid-sparing pain management protocol. HOOS, JR. scores, pain severity using a Visual Analogue Scale (VAS), and inpatient/post-discharge morphine milligram equivalents (MMEs) per day were compared between the two cohorts.
There were 303 (45.3%) patients in the traditional pain management cohort and 366 (54.7%) in the opioid-sparing cohort. No statistically significant difference was observed in HOOS, JR. scores between the two cohorts at any time-point. All patients experienced a significant decrease in pain scores over time, but there was no statistically significant difference in the rates of change between the two pain management protocols. Inpatient opioid consumption was significantly lower for the opioid-sparing cohort in comparison to the traditional cohort (14.6 ± 16.7 MME/day vs. 25.7 ± 18.8 MME/day), as were opioids prescribed during the post-discharge period (13.9 ± 24.2 MME vs. 80.1 ± 55.9 MME).
The results of this study suggest that an opioid-sparing protocol reduces opioid consumption and provides equivalent pain management and PROs during the 90-day THA episode of care relative to a traditional opioid-based regimen. These findings may help decrease the risk of adverse events associated with postoperative opioid use and provide a means of decreasing the opioid footprint in clinical practice.