New York, NY—May 26, 2017
When considering joint replacement, many patients worry about how much pain they’ll experience after surgery. It’s a valid concern. Pain control is important not only to avoid discomfort. It’s also essential to get a handle on pain early on so patients can move around and engage in a physical therapy program.
"At Hospital for Special Surgery, we’ve studied pain control at length and have excellent pain management protocols for patients who have joint replacement," explains Geoffrey Westrich, MD, research director of the Adult Reconstruction and Joint Replacement Service at Hospital for Special Surgery (HSS). "We generally strive to lower patients' use of narcotic medications, known as opioids. Although these medications do a good job at controlling pain, they can have side effects such as nausea, vomiting, dizziness, drowsiness and constipation, which are not only unpleasant, but can make physical therapy more difficult."
Dr. Westrich and colleagues just launched a study to see if intravenous (IV) acetaminophen can reduce the amount of opioid pain medicine needed after hip replacement surgery. Currently, joint replacement patients generally receive opioid medication along with the pill form of acetaminophen, commonly known as Tylenol.
"We decided to undertake this study because research shows that acetaminophen in IV form reaches a higher peak concentration in the blood much faster than oral acetaminophen, and therefore crosses the blood-brain barrier much more quickly. The brain is the target organ where acetaminophen works to reduce pain," Dr. Westrich explained. "We hypothesize that the intravenous form will be better at alleviating pain after hip replacement than the oral pill form."
Dr. Westrich and colleagues aim to determine if patients in the IV acetaminophen group have sufficient pain relief to be able to substantially reduce their opioid intake and accompanying side effects, and if they achieve physical therapy goals more quickly. So far, patients have been very receptive to participating in the study.
All patients will receive the standard pain control protocol, with one group getting IV acetaminophen, while the other group receives the oral pill form. Since it is a randomized, double-blinded study, neither the patients nor their doctors will know which individuals are receiving intravenous vs. oral acetaminophen. Patients receiving the IV acetaminophen will also receive a placebo in pill form, and those receiving oral acetaminophen will receive a placebo IV solution.
In addition to seeing if IV acetaminophen leads to lower doses of opioid medication, researchers will be measuring sedation effects, the achievement of physical therapy milestones, and length of hospital stay in patients given intravenous vs. oral acetaminophen.
"Because of its efficacy, general safety profile and lower risk of adverse effects compared to other pain medications, intravenous acetaminophen could be an attractive component of the overall pain management plan," Dr. Westrich said. "If we find that the IV form safely reduces the need for opioid medication, it would be advantageous for hip replacement patients."
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 on 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.