Boston, MA—October 21, 2017
Opioid use is decreasing in patients undergoing total knee or hip replacements, which may be due in part to an increase in multimodal analgesia techniques, results of a study presented at the American Society of Anesthesiologists annual meeting on October 21 in Boston, Massachusetts suggest. Researchers from several hospitals, including Hospital for Special Surgery, reviewed data from more than 1,100,000 total hip and total knee arthroplasty patients captured in the national Premier Perspective database from 2006 to 2014.
The investigators sought to analyze the impact of multimodal pain management, commonly referred to as multimodal analgesia, on postoperative pain in total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients from more than 546 hospitals nationwide.
"Multimodal analgesia is an important perioperative pain management approach, because it balances the effectiveness of each type, or mode, of pain relief with the side effects of other types of pain relief, like opioids," explains Stavros Memtsoudis, MD, PhD, a study author and senior scientist and anesthesiologist in the Department of Anesthesiology. Multimodal analgesia techniques are often tailored to the individual patient and their procedure and may incorporate several methods of pain relief.
In order to measure trends in multimodal analgesia techniques, the investigators examined utilization rates among four groups of patients: 1) patients who received only opioids; 2) patients who received opioids in addition to one other analgesia mode; 3) patients who received opioids in addition to two complementary analgesic modes; and 4) patients who received opioids in combination with more than two analgesic modes. The alternative modes reviewed for this study included peripheral nerve block, intravenous acetaminophen, gabapentin/pregablin, non-steroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors, and ketamine.
Among THA patients studied, nearly 18 percent did not receive any multimodal pain management compared with 14 percent of TKA patients. The largest percentage of patients in both groups – 37 percent and 36 percent for THA and TKA, respectively – received opioids and one additional mode of analgesia. While the differences were modest, multimodal analgesic strategies were used more often in small and medium-sized hospitals (defined as 300 to 499 beds) – 83 percent of the time, compared to 80 percent of the time in larger hospitals – in patients undergoing THAs. The researchers noted that the same pattern was seen in TKA patients
Overall, the use of multimodal analgesia techniques increased sharply, coinciding with a decrease in opioid use in both TKA and THA patients. "Patients are being increasingly treated with multimodal approach to pain control,” said Dr. Memtousdis. “With increasing emphasis on limiting opioid use, this change identifies alternative possibilities for successfully treating post-operative pain."
Gerner P, Poeran J, Cozowicz C, Morwald E, Zubizarreta N, Mazumdar M, Memtsoudis SG. "Multimodal Pain Management in Total Hip and Knee Arthroplasty – Trends over the Last 10 Years." Poster presented at: American Society of Anesthesiologists 2017 Annual Meeting; October 21 – 24; Boston, MA.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic of musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.