Opioid Use Among Hip And Knee Replacement Patients Declining, Study Finds

Following hip and knee replacement surgery, less opioids are prescribed for pain management than in prior years, according to the findings of new research. 

In a study presented last week at an annual meeting of anesthesiologists, researchers indicate that doctors are using more than one way to treat surgical pain. Instead of simply prescribing narcotic painkillers, doctors are turning to multimodal therapies, or using more than one method to treat pain.

Prior research focusing on opioid use after hernia repair indicated patients may need fewer painkillers during recovery than previously believed. Researchers believe this should prompt the reevaluation of opioid prescription practices in the U.S.

In this latest study, researchers used Premiere Perspective, a national database with information on joint replacement surgeries performed at 546 hospitals. The study included more than 1 million hip and knee replacement patients and is the first to focus on how multimodal strategies have evolved in recent years. Nearly 400,000 hip replacements and 800,000 knee replacement surgeries were conducted between 2006 and 2014.

Patients were given opioid painkillers, such as Vicodin and Percocet, and in some cases they were offered opioids as well as one to three other forms of pain management, such as peripheral nerve block, acetaminophen, gabapentin/pregabalin, non-steroidal anti-inflammations (NSAIDs), COX-2 inhibitors, or ketamine.

Researchers indicated one in four people were prescribed only opioids after hip and knee replacement surgeries in 2006. By 2014, the numbers decreased to one in 12.

In light of the growing opioid abuse epidemic in the United States, doctors and health experts are focused on ways to reduce addiction to the powerful painkillers. Researchers indicate the problem may be even worse, as opioid overdoses are severely underreported.

In the new study, the number of patients who used only opioids to treat their post-operative pain decreased by one-third from 2006 to 2014.

Approximately 27% of patients received only opioids to manage their pain in 2006. In 2014, only about 10% of patients used only opioids. Specifically among patients who had a knee replacement, about 23% used only opioids in 2006. Comparatively, by 2014, 7% used only opioids to manage their pain.

Overall, multimodal therapy was more commonly used among patients who had joint replacement surgery at small or medium sized hospitals, compared to large hospitals. Researchers indicate this may be because smaller hospitals are more open to implementing new and changing procedures to stay competitive.

More than 1 million people have hip or knee replacement surgery every year in the United States. Most receive opioids to manage their pain and about 30% develop chronic pain, requiring ongoing use of opioids after surgery recovery.

The newest study indicates progress is being made to work toward fewer opioid prescriptions in the face of the worsening opioid abuse and overdose epidemic.