Reduction of Opioids Prescribed Upon Discharge After Total Knee Arthroplasty Significantly Reduces Consumption: A Prospective Study Comparing Two States

被引:11
作者
Chalmers, Brian P. [1 ]
Mayman, David J. [1 ]
Jerabek, Seth A. [1 ]
Sculco, Peter K. [1 ]
Haas, Steven B. [1 ]
Ast, Michael P. [1 ]
机构
[1] Hosp Special Surg, Dept Orthoped Surg Adult Reconstruct & Joint Repl, 535 East 70th St, New York, NY 10021 USA
关键词
total knee arthroplasty; total hip arthroplasty; opioids; narcotics; abuse; opioid epidemic; PRESCRIPTIONS; ABUSE;
D O I
10.1016/j.arth.2020.07.032
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
Background: Opioids prescribed for acute pain after total knee arthroplasty (TKA) play a contributing role in the number of opioid pills in circulation. At the height of an opioid epidemic in the United States, opioids are increasingly diverted, misused, and abused. Therefore, many states have enacted narcotic regulations in an attempt to curb opioid diversion and misuse. The purpose of this study is to evaluate the effect of stricter state prescribing regulations on opioid consumption following TKA. Methods: In total, 165 opioid-naive patients undergoing primary unilateral TKA at a single institution with a standardized perioperative pain protocol were reviewed. Seventy-one patients (group 1) resided in a state with strict opioid regulations that limit the initial number of pills dispensed and refills, whereas 92 patients (group 2) resided in another state without quantity and refill regulations. Patient demographics were similar between the 2 groups. Mean age was 64 and mean body mass index was 32 kg/m(2). Opioid consumption, quantity, and refill patterns were collected for 6 weeks following surgery. Results: The average oral morphine equivalents consumed during the 6 weeks postsurgery were significantly lower in group 1 at 446.3 +/- 266.3 mg (range 10-992) compared to group 2 at 622.6 +/- 313.7 mg (range 20-1416) (P < .001). The average oral morphine equivalent corresponds to 60 tablets of 5 mg oxycodone per patient in group 1 vs 84 tablets per patient in group 2. Fifty-nine (83%) patients in group 1 had stopped taking opioids within 6 weeks of surgery compared to 59 (64%) in group 2 (P = .04). Conclusion: Based on our results, the institution of state regulations aimed at decreasing the quantity and refills of postoperative opioids led patients to consume less opioids following TKA. Many patients are prescribed more opioids than they require which increases their consumption and can increase the risk for diversion, addiction, and misuse. (C) 2020 Elsevier Inc. All rights reserved.
引用
收藏
页码:160 / 163
页数:4
相关论文
共 18 条
[1]
[Anonymous], 2012, PAIN PHYS S
[2]
The Public and the Opioid-Abuse Epidemic [J].
Blendon, Robert J. ;
Benson, John M. .
NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (05) :407-411
[3]
New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults [J].
Brummett, Chad M. ;
Waljee, Jennifer F. ;
Goesling, Jenna ;
Moser, Stephanie ;
Lin, Paul ;
Englesbe, Michael J. ;
Bohnert, Amy S. B. ;
Kheterpal, Sachin ;
Nallamothu, Brahmajee K. .
JAMA SURGERY, 2017, 152 (06)
[4]
Dart RC, 2015, NEW ENGL J MED, V372, P241, DOI [10.1056/NEJMsa1406143, 10.1056/NEJMc1501822]
[5]
Does the Amount of Opioid Consumed Influence How Patients Rate Their Experience of Care After Total Knee Arthroplasty? [J].
Etcheson, Jennifer, I ;
Gwam, Chukwuweike U. ;
George, Nicole E. ;
Caughran, Alexander T. ;
Mont, Michael A. ;
Delanois, Ronald E. .
JOURNAL OF ARTHROPLASTY, 2018, 33 (11) :3407-3411
[6]
Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic [J].
Hah, Jennifer M. ;
Bateman, Brian T. ;
Ratliff, John ;
Curtin, Catherine ;
Sun, Eric .
ANESTHESIA AND ANALGESIA, 2017, 125 (05) :1733-1740
[7]
Anesthesia and Analgesia Practices in Total Joint Arthroplasty: A Survey of the American Association of Hip and Knee Surgeons Membership [J].
Hannon, Charles P. ;
Keating, Timothy C. ;
Lange, Jeffrey K. ;
Ricciardi, Benjamin E. ;
Waddell, Bradford S. ;
Della Valle, Craig J. .
JOURNAL OF ARTHROPLASTY, 2019, 34 (12) :2872-+
[8]
Patients at Risk: Large Opioid Prescriptions After Total Knee Arthroplasty [J].
Hernandez, Nicholas M. ;
Parry, Joshua A. ;
Taunton, Michael J. .
JOURNAL OF ARTHROPLASTY, 2017, 32 (08) :2395-2398
[9]
Opioid Prescribers to Total Joint Arthroplasty Patients Before and After Surgery: The Majority Are Not Orthopedists [J].
Namba, Robert S. ;
Paxton, Elizabeth W. ;
Inacio, Maria C. .
JOURNAL OF ARTHROPLASTY, 2018, 33 (10) :3118-+
[10]
*NAT C STAT LEG, INJ PREV LEG DAT