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.