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Eliminating Extended-Release Opioids from a Postoperative Pain Protocol for Total Knee Replacement Patients
Anoush Kalachian1, Judith Barberio2, Jill Cox2
1Englewood Health, Englewood, New Jersey.
Summary
Eliminating extended-release (ER) opioids in total knee replacement (TKR) patients improved outcomes by reducing antiemetic use and increasing home discharges. This study supports guideline recommendations against ER opioids for TKR patients.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Pharmacology
Background:
- Multimodal pain management is crucial for total knee replacement (TKR) patients.
- Extended-release (ER) opioids are often part of postoperative pain regimens.
- Guidelines recommend against ER opioid use in certain surgical populations.
Purpose of the Study:
- To evaluate the impact of removing ER opioids from TKR patient medication.
- To determine if this change improves patient outcomes.
- To assess effects on hospital length of stay, pain scores, and opioid consumption.
Main Methods:
- Retrospective cohort quality improvement study.
- Chart review of TKR patients (n=60) before and after protocol change.
- Outcomes analyzed: length of stay, discharge disposition, pain scores, antiemetic use, opioid dose, and prescriptions.
Main Results:
- Reduced antiemetic use (p = .03).
- Trend towards shorter length of stay (p = .33).
- Significantly more patients discharged home versus rehabilitation (p < .001).
- Standardized discharge opioid prescriptions (30 tablets, no refills).
Conclusions:
- Eliminating ER opioids in TKR patients is associated with improved outcomes.
- This practice change aligns with current guidelines and promotes patient safety.
- Potential to reduce opioid overprescription and overconsumption in orthopedic surgery.
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