Case Study and Literature Review: Patient-Controlled Opioid-Free Surgical Pathway for Right Total Hip Arthroplasty

Introduction: Total hip arthroplasty (THA) is a procedure widely used to relieve pain and restore mobility in patients with hip joint disorders such as osteoarthritis. Traditionally, post-operative pain management has depended on opioids. However, growing concerns about opioid-related side effects and the risk of long-term opioid dependence have led to an increased interest in opioid-sparing approaches. Although regional anesthesia and non-opioid pharmacologic options show promise, studies report that opioid-free anesthesia is achieved in only 46.7% and 12% of cases, respectively. With a rising number of patients expressing a desire to avoid opioids due to fear of addiction, our team developed a patient-controlled opioid-free surgical pathway (PCOFSP). This pathway is based on a patient-specific, multidisciplinary approach that includes care coordination across the perioperative team, targeted education for patients and staff, patient identification on the day of surgery facilitated by opioid-free wristbands and chart labels, and a special order set ensuring the use of non-opioid analgesics with multimodal care, regional anesthesia, and complementary techniques. Each care plan is personalized to address both the physical and the emotional aspects of pain.

A 67-year-old Caucasian male with bilateral hip osteoarthritis elected to undergo a left THA, followed 5 months later by a right THA. On both occasions, he declined the use of opioids. Initially, the patient was not identified for the PCOFSP because the surgeon had not agreed to the regional anesthesia program requirement. After the patient firmly requested an opioid-free experience and the surgeon agreed to regional anesthesia, he was enrolled. For his left THA, the patient used mindful breathing, ice therapy, and aromatherapy with Elequil Aromatabs® Lavender-Peppermint (Beekley Corporation, Bristol, CT). For the right THA, although regional anesthesia was not requested, the patient again refused opioids. The surgical and acute pain teams collaborated, and the nurse practitioner developed a personalized care plan, incorporating mindful breathing, aromatherapy, NeuroCuple™ patches (nCap Medical LLC, Heber City, UT), and lidocaine patches.

This case illustrates that the PCOFSP can enable patients to successfully undergo opioid-free THA. Although patients can choose different complementary techniques for each surgery, the proposed multidisciplinary and multimodal approach represents an effective strategy.