Topical Cannabidiol Did Not Reduce Opioid Consumption After Knee Arthroplasty

After total knee arthroplasty (TKA), topical cannabidiol (CBD) did not reduce pain or opioid consumption, according to results of a randomized double-blind, placebo-controlled study, published in The Journal of Arthroplasty.

Patients (N=90) undergoing primary unilateral TKA between 2020 and 2021 at Thomas Jefferson University in the United States were recruited for this study. Patients were randomized in a 1:1:1:1 ratio to receive CBD alone (n=19), essential oils (EO) alone (n=21), CBD with EO (n=21), or placebo (n=19).

After the TKA procedure, patients were instructed to apply the topical formulation after the anesthesia wore off and to continue to apply the formulation 3 times per day until postoperative day 14. The primary outcomes were postoperative pain, opioid use, sleep scores, extremity functional scores, and patient-reported outcomes.

The patient cohorts were aged mean 64.1-67.3 years, 36.8%-57.1% were men, 85.7%-95.2% were White, 61.9%-78.9% received a cruciate retaining implant, the length of surgery was 70.1-73.8 minutes, length of hospital stay was 25.7-27.0 hours, and time to first narcotic use was 5.25-7.90 hours.

Cohort mean preoperative pain ranged from 48.3-54.4 points on a visual analogue scale (VAS) and did not differ between groups (P =.781). On postoperative day 1, pain scores ranged from 28.1-32.9 points (P =.809), increasing during the first 2 weeks after surgery and returning to 20.2 to 29.6 points on postoperative day 42 (P =.675). The only difference in pain scores between groups was observed on postoperative day 2, in which the EO recipients reported lower pain scores (mean, 51.0 vs 61.0-69.9 points; P =.026).

No significant group differences were observed for opioid consumption or sleep scores.

For functional outcomes, placebo recipients had higher Lower Extremity Function Scale (LEFS) scores on postoperative day 14 (mean, 42.5 vs 30.1-37.8; P =.050) and EO recipients had higher Short Form 12-Item Physical Component Score (SF-12 PCS) on postoperative day 42 (mean, 39.4 vs 30.6-35.7; P =.021).

In the multiple comparison analysis, EO was favored over CBD for VAS scores on postoperative day 2 (P =.013), CBD was favored over placebo for LEFS scores on postoperative day 14 (P =.040), and CBD-EO was favored over EO for SF-12 PCS on postoperative day 42 (P =.010).

No patients reported a reaction to the topical placebo or CBD-EO formulations. One patient in each group reported a mild erythematous reaction to the CBD and EO formulations. The patient who had a reaction to the EO formulation discontinued use.

One patient randomized to receive placebo was readmitted to the hospital due to shortness of breath.

This study was limited by not monitoring patient use of the topical formulation.

These findings did not support the use of topical CBD for reducing pain or opioid consumption following TKA.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Haffar A, Khan IA, Abdelaal MS, Banerjee S, Sharkey PF, Lonner JH. Topical cannabidiol (cbd) after total knee arthroplasty does not decrease pain or opioid use: A prospective randomized double-blinded placebo-controlled trial. J Arthroplasty. 2022;S0883-5403(22)00383-7. doi:10.1016/j.arth.2022.03.081