The Efficacy and Safety of Opioids in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis |
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| Affiliation: | 1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL;2. Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH;3. Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA;4. OrthoCarolina Hip and Knee Center, Charlotte, NC;5. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY;6. Department of Research, Quality, and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, IL;7. Anderson Orthopedic Research Institute, Alexandria, VA;1. Orthopedic Surgery, Spectrum Health, Grand Rapids, MI;2. Anesthesiology, University of Michigan, Ann Arbor, MI;3. Orthopedic Surgery, McLaren Flint, Flint, MI;4. Orthopedic Surgery, Sparrow Hospital, Lansing, MI;5. Orthopedic Surgery, Ascension Genesys Hospital, Grand Blanc, MI;6. Orthopedic Surgery, University of Michigan, Ann Arbor, MI;7. Orthopedic Surgery, Henry Ford Hospital, Detroit, MI;8. Orthopedic Surgery, St. Joseph Mercy Chelsea Hospital, Chelsea, MI;1. Department of Orthopedic Surgery, NYU Langone Health, New York, NY;2. Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI |
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| Abstract: | BackgroundOpioids are frequently used to treat pain after total joint arthroplasty (TJA). The purpose of this study was to evaluate the efficacy and safety of opioids in primary TJA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and the American Society of Regional Anesthesia and Pain Management.MethodsThe MEDLINE, EMBASE, and Cochrane Central Register of controlled trials were searched for studies published before November 2018 on opioids in TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of opioids.ResultsPreoperative opioid use leads to increased opioid consumption and complications after TJA along with a higher risk of chronic opioid use and inferior patient-reported outcomes. Scheduled opioids administered preemptively, intraoperatively, or postoperatively reduce the need for additional opioids for breakthrough pain. Prescribing fewer opioid pills after discharge is associated with equivalent functional outcomes and decreased opioid consumption. Tramadol reduces postoperative opioid consumption but increases the risk of postoperative nausea, vomiting, dry mouth, and dizziness.ConclusionModerate evidence supports the use of opioids in TJA to reduce postoperative pain and opioid consumption. Opioids should be used cautiously as they may increase the risk of complications, such as respiratory depression and sedation, especially if combined with other central nervous system depressants or used in the elderly. |
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| Keywords: | opioids tramadol pain management total hip arthroplasty total knee arthroplasty |
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