Evaluation of Low-Dose Versus High-Dose Opioid Pathway in Opioid-Naïve Patients After Total Knee Arthroplasty
Background: Pain control after total knee arthroplasty (TKA) remains challenging. Tramadol is a weak opioid with potentially lower side effects and risk for dependency than stronger opioids. The purpose of this study was to evaluate efficacy and safety of tramadol after TKA in opioid-naïve patients...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-04-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344121002375 |
| _version_ | 1818278812392095744 |
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| author | Lindsay Kleeman-Forsthuber, MD Aviva Pollet, BS Roseann M. Johnson, BS, CCRP James Boyle, PA Jason M. Jennings, MD, DPT Douglas A. Dennis, MD |
| author_facet | Lindsay Kleeman-Forsthuber, MD Aviva Pollet, BS Roseann M. Johnson, BS, CCRP James Boyle, PA Jason M. Jennings, MD, DPT Douglas A. Dennis, MD |
| author_sort | Lindsay Kleeman-Forsthuber, MD |
| collection | DOAJ |
| description | Background: Pain control after total knee arthroplasty (TKA) remains challenging. Tramadol is a weak opioid with potentially lower side effects and risk for dependency than stronger opioids. The purpose of this study was to evaluate efficacy and safety of tramadol after TKA in opioid-naïve patients compared with stronger opioids. Methods: A retrospective review of patients who underwent primary TKA was performed. In September 2018, opioid-naïve patients were prescribed tramadol instead of oxycodone. Patients receiving tramadol (low-opioid group) were matched to patients discharged with oxycodone before this transition (high-opioid group). We compared morphine milligram equivalent (MME) consumption and outcomes up to 3 months postoperatively. Results: Two-hundred and five patients underwent TKA, with 126 receiving tramadol. Fourteen patients were converted to stronger opioid (11.2% conversion rate). Seventy patients from the low-opioid group were matched to 70 patients in the high-opioid group. Average daily inpatient MME consumption was higher in the high-opioid group (40.0 ± 27.4 vs 16.3 ± 10.9, P = .000). Outpatient prescribed MME was significantly higher in the high-opioid group (135.5 ± 71.5 vs 75.3 ± 51.3, P = .000) along with a higher number of refills (0.53 ± 1.1 vs 0.886 ± 0.94, P = .041). Knee range of motion was not statistically different at any timepoint postoperatively. There was higher adverse event rate in the low-opioid group (8.6% vs 5.7%) but not statically significant. Conclusions: Low opioid regimen following TKA showed lower MME consumption than high opioid regimen with no effect on outcomes up to 3 months. Use of low opioid regimen should be considered for TKA surgery. |
| first_indexed | 2024-12-12T23:23:23Z |
| format | Article |
| id | doaj.art-d42b55f51e0d43679732a843c619d543 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-12-12T23:23:23Z |
| publishDate | 2022-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-d42b55f51e0d43679732a843c619d5432022-12-22T00:08:12ZengElsevierArthroplasty Today2352-34412022-04-01148185Evaluation of Low-Dose Versus High-Dose Opioid Pathway in Opioid-Naïve Patients After Total Knee ArthroplastyLindsay Kleeman-Forsthuber, MD0Aviva Pollet, BS1Roseann M. Johnson, BS, CCRP2James Boyle, PA3Jason M. Jennings, MD, DPT4Douglas A. Dennis, MD5Colorado Joint Replacement, Denver, CO, USA; Corresponding author. Thomas W. Huebner Medical Office Building, 160 Allen Street, Rutland, VT 05701, USA. Tel.: + 1 8027752937.Colorado Joint Replacement, Denver, CO, USAColorado Joint Replacement, Denver, CO, USAColorado Joint Replacement, Denver, CO, USAColorado Joint Replacement, Denver, CO, USA; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USAColorado Joint Replacement, Denver, CO, USA; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USABackground: Pain control after total knee arthroplasty (TKA) remains challenging. Tramadol is a weak opioid with potentially lower side effects and risk for dependency than stronger opioids. The purpose of this study was to evaluate efficacy and safety of tramadol after TKA in opioid-naïve patients compared with stronger opioids. Methods: A retrospective review of patients who underwent primary TKA was performed. In September 2018, opioid-naïve patients were prescribed tramadol instead of oxycodone. Patients receiving tramadol (low-opioid group) were matched to patients discharged with oxycodone before this transition (high-opioid group). We compared morphine milligram equivalent (MME) consumption and outcomes up to 3 months postoperatively. Results: Two-hundred and five patients underwent TKA, with 126 receiving tramadol. Fourteen patients were converted to stronger opioid (11.2% conversion rate). Seventy patients from the low-opioid group were matched to 70 patients in the high-opioid group. Average daily inpatient MME consumption was higher in the high-opioid group (40.0 ± 27.4 vs 16.3 ± 10.9, P = .000). Outpatient prescribed MME was significantly higher in the high-opioid group (135.5 ± 71.5 vs 75.3 ± 51.3, P = .000) along with a higher number of refills (0.53 ± 1.1 vs 0.886 ± 0.94, P = .041). Knee range of motion was not statistically different at any timepoint postoperatively. There was higher adverse event rate in the low-opioid group (8.6% vs 5.7%) but not statically significant. Conclusions: Low opioid regimen following TKA showed lower MME consumption than high opioid regimen with no effect on outcomes up to 3 months. Use of low opioid regimen should be considered for TKA surgery.http://www.sciencedirect.com/science/article/pii/S2352344121002375Low opioidTramadolTotal knee arthroplastySafetyEfficacy |
| spellingShingle | Lindsay Kleeman-Forsthuber, MD Aviva Pollet, BS Roseann M. Johnson, BS, CCRP James Boyle, PA Jason M. Jennings, MD, DPT Douglas A. Dennis, MD Evaluation of Low-Dose Versus High-Dose Opioid Pathway in Opioid-Naïve Patients After Total Knee Arthroplasty Arthroplasty Today Low opioid Tramadol Total knee arthroplasty Safety Efficacy |
| title | Evaluation of Low-Dose Versus High-Dose Opioid Pathway in Opioid-Naïve Patients After Total Knee Arthroplasty |
| title_full | Evaluation of Low-Dose Versus High-Dose Opioid Pathway in Opioid-Naïve Patients After Total Knee Arthroplasty |
| title_fullStr | Evaluation of Low-Dose Versus High-Dose Opioid Pathway in Opioid-Naïve Patients After Total Knee Arthroplasty |
| title_full_unstemmed | Evaluation of Low-Dose Versus High-Dose Opioid Pathway in Opioid-Naïve Patients After Total Knee Arthroplasty |
| title_short | Evaluation of Low-Dose Versus High-Dose Opioid Pathway in Opioid-Naïve Patients After Total Knee Arthroplasty |
| title_sort | evaluation of low dose versus high dose opioid pathway in opioid naive patients after total knee arthroplasty |
| topic | Low opioid Tramadol Total knee arthroplasty Safety Efficacy |
| url | http://www.sciencedirect.com/science/article/pii/S2352344121002375 |
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