We reviewed six studies that compared the influence of an opioid administered pre-emptively immediately prior to TJA to placebo on postoperative outcomes after TJA.
All six studies reported visual analogue pain scores (VAS) within 72 hours after TJA after administration of an opioid pre-emptively prior to TJA. Four of the high quality studies found that an opioid administered pre-emptively prior to surgery resulted in lower VAS scores within 72 hours after TJA compared to placebo.
All six studies evaluated opioid consumption within 72 hours after TJA. Five of the six studies found that administration of an opioid pre-emptively prior to TJA resulted in lower morphine consumption after TJA compared to placebo.
Direct meta-analyses were performed to compare rates of nausea, vomiting, and urinary retention. The direct meta-analyses found no difference between patients who received a pre-emptive opioid prior to TJA and placebo in rates of nausea (0.88 relative risk; 95% confidence interval 0.62 to 1.25), vomiting (0.60 relative risk; 95% confidence interval 0.33 to 1.10), and urinary retention (1.08 relative risk; 95% confidence interval 0.34 to 3.40). Four studies evaluated sedation and respiratory depression and found no difference between pre-emptive opioids and placebo. [16,17,19,21]
However, it is the opinion of the workgroup that when combined with other opioids administered during the perioperative period, such as intraoperatively or postoperatively, opioids administered prior to surgery may increase the risk of complications including respiratory depression and sedation.
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