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The Efficacy and Safety of Opioids in Total Joint Arthroplasty: A Direct Meta-Analysis.
J Arthroplasty. 2020 May 27 [Online ahead of print]JA

Abstract

BACKGROUND

Opioids are frequently used to treat pain after total joint arthroplasty (TJA). The purpose of this study was to evaluate the efficacy and safety of opioids in primary TJA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and the American Society of Regional Anesthesia and Pain Management.

METHODS

The MEDLINE, EMBASE, and Cochrane Central Register of controlled trials were searched for studies published before September 2019 on opioids in TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of opioids.

RESULTS

Preoperative opioid use leads to increased opioid consumption and complications after TJA along with a higher risk of chronic opioid use and inferior patient-reported outcomes. Scheduled opioids administered preemptively, intraoperatively, or postoperatively reduce the need for additional opioids for breakthrough pain. Prescribing fewer opioid pills after discharge is associated with equivalent functional outcomes and decreased opioid consumption. Tramadol reduces postoperative opioid consumption but increases the risk of postoperative nausea, vomiting, dry mouth, and dizziness.

CONCLUSION

Moderate evidence supports the use of opioids in TJA to reduce postoperative pain and opioid consumption. Opioids should be used cautiously as they may increase the risk of complications, such as respiratory depression and sedation, especially if combined with other central nervous system depressants or used in the elderly.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA.OrthoCarolina Hip and Knee Center, Charlotte, NC.Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.Department of Research, Quality, and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, IL.Department of Research, Quality, and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, IL.Department of Research, Quality, and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, IL.Anderson Orthopedic Research Institute, Alexandria, VA.Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32571589

Citation

Hannon, Charles P., et al. "The Efficacy and Safety of Opioids in Total Joint Arthroplasty: a Direct Meta-Analysis." The Journal of Arthroplasty, 2020.
Hannon CP, Fillingham YA, Nam D, et al. The Efficacy and Safety of Opioids in Total Joint Arthroplasty: A Direct Meta-Analysis. J Arthroplasty. 2020.
Hannon, C. P., Fillingham, Y. A., Nam, D., Courtney, P. M., Curtin, B. M., Vigdorchik, J., Mullen, K., Casambre, F., Riley, C., Hamilton, W. G., & Della Valle, C. J. (2020). The Efficacy and Safety of Opioids in Total Joint Arthroplasty: A Direct Meta-Analysis. The Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2020.05.032
Hannon CP, et al. The Efficacy and Safety of Opioids in Total Joint Arthroplasty: a Direct Meta-Analysis. J Arthroplasty. 2020 May 27; PubMed PMID: 32571589.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Efficacy and Safety of Opioids in Total Joint Arthroplasty: A Direct Meta-Analysis. AU - Hannon,Charles P, AU - Fillingham,Yale A, AU - Nam,Denis, AU - Courtney,P Maxwell, AU - Curtin,Brian M, AU - Vigdorchik,Jonathan, AU - Mullen,Kyle, AU - Casambre,Francisco, AU - Riley,Connor, AU - Hamilton,William G, AU - Della Valle,Craig J, Y1 - 2020/05/27/ PY - 2020/05/06/received PY - 2020/05/18/accepted PY - 2020/6/24/entrez KW - opioids KW - pain management KW - total hip arthroplasty KW - total knee arthroplasty KW - tramadol JF - The Journal of arthroplasty JO - J Arthroplasty N2 - BACKGROUND: Opioids are frequently used to treat pain after total joint arthroplasty (TJA). The purpose of this study was to evaluate the efficacy and safety of opioids in primary TJA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and the American Society of Regional Anesthesia and Pain Management. METHODS: The MEDLINE, EMBASE, and Cochrane Central Register of controlled trials were searched for studies published before September 2019 on opioids in TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of opioids. RESULTS: Preoperative opioid use leads to increased opioid consumption and complications after TJA along with a higher risk of chronic opioid use and inferior patient-reported outcomes. Scheduled opioids administered preemptively, intraoperatively, or postoperatively reduce the need for additional opioids for breakthrough pain. Prescribing fewer opioid pills after discharge is associated with equivalent functional outcomes and decreased opioid consumption. Tramadol reduces postoperative opioid consumption but increases the risk of postoperative nausea, vomiting, dry mouth, and dizziness. CONCLUSION: Moderate evidence supports the use of opioids in TJA to reduce postoperative pain and opioid consumption. Opioids should be used cautiously as they may increase the risk of complications, such as respiratory depression and sedation, especially if combined with other central nervous system depressants or used in the elderly. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/32571589/The_Efficacy_and_Safety_of_Opioids_in_Total_Joint_Arthroplasty:_A_Direct_Meta-Analysis L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(20)30572-6 DB - PRIME DP - Unbound Medicine ER -
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