Strategies for Opioid Minimization Following Total Knee Arthroplasty: A Comprehensive Review

Area of Science:

• Orthopaedic Surgery
• Pain Management
• Pharmacology

Background:

• The opioid epidemic necessitates re-evaluating pain management after total knee arthroplasty (TKA).
• TKA patients historically experience significant postoperative pain, often managed with opioids.

Purpose of the Study:

• To explore tiered, multimodal pain management strategies for opioid-naïve TKA patients.
• To assess the effectiveness of non-opioid-centric approaches in reducing opioid exposure and improving outcomes.

Main Methods:

• Implementing a tiered regimen starting with non-opioids (acetaminophen, NSAIDs, gabapentinoids), escalating to tramadol or stronger opioids only if necessary.
• Incorporating preoperative cryoneurolysis, intraoperative nerve blocks, and long-acting local anesthetics.
• Leveraging real-world data from registries like Innovations in Genicular Outcomes Research (iGOR).

Main Results:

• Demonstrated effectiveness of tiered, multimodal regimens in reducing opioid consumption post-TKA.
• Observed improvements in functional recovery and quality-of-life outcomes.
• Supported by the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act providing Medicare reimbursement for non-opioid treatments.

Conclusions:

• A convergence of clinical strategies, policy (NOPAIN Act), and data infrastructure offers a sustainable framework for opioid stewardship in orthopaedic surgery.
• This approach can advance opioid reduction without compromising patient comfort or recovery after TKA.