Multimodal Pain Management Increasingly Used for Patients Undergoing TKA and THA

Patients undergoing total hip and total knee arthroplasties in small- and medium-sized hospitals have been receiving increasingly greater multimodal approaches for postoperative pain management.
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The use of multimodal approaches for postoperative pain is increasing for patients undergoing total hip arthroplasty (THAs) and total knee arthroplasty (TKAs) in small- and medium-sized hospitals, lessening the amount of opioid medications these patients receive, according to a study presented at Anesthesiology 2017, held October 21-25 in Boston, Massachusetts.

“Over 1 million patients undergo total joint arthroplasty surgery in the United States alone every year, with the minority experiencing significant pain postoperatively,” wrote the authors of the current study.

“Concurrently, increasing awareness of safe opioid prescribing has created an increased interest in alternate, effective postoperative pain management,” they added.

Investigators identified patients who had undergone THA (n=377,657) and TKA (n=779,338) between 2006 and 2014 and for whom treatment modalities were recorded in the Premier Perspective database.

A total of 66,484 (17.6%) people who underwent THA were not treated using a multimodal postoperative pain management approach during this period. Comparatively, approximately 37.2% (n=140,622), 29.0% (n=109,640), and 16.1% (n=60,911) were administered opioid medications in combination with 1, 2, and 3 additional treatments, respectively. These treatments included nonsteroidal anti-inflammatory drugs; cyclooxygenase-2 inhibitors; peripheral nerve block; intravenous acetaminophen, gabapentin, or pregabalin; and ketamine.

Multimodal pain management strategies were used more frequently among those who underwent THA who were receiving care in small- and medium-sized hospitals (<300-499 beds) compared with larger hospitals (83%-84% vs 80%, respectively; P <.0001). Researchers observed similar trends among patients undergoing TKA.

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In addition, the proportion of patients undergoing THA who did not receive a multimodal pain management strategy decreased between 2006 and 2014 from 27.2% to 10.1% (P <.0001).

“With increasing emphasis on limiting opioid use, this change displays alternate possibilities for successfully treating postoperative pain,” concluded the authors.

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Gerner P, Poeran J, Cozowicz C, et al. Multimodal pain management in total hip and knee arthroplasty: trends over the last 10 years. Presented at: Anesthesiology 2017; October 21-25, 2017; Boston, MA. Abstract A1069.