Opioids Administered Intraoperatively
An opioid administered intraoperatively reduces opioid consumption, but does not affect postoperative pain within 72 hours after surgery. An opioid administered intraoperatively may increase the risk of complications, such as respiratory depression or sedation, especially if combined with other opioids administered preoperatively or postoperatively.
Anesthesia and Analgesia in Total Joint Arthroplasty
Developed by: American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, The Hip Society, and The Knee Society

Rationale

We reviewed two high quality studies that evaluated the influence of an opioid administered intraoperatively during primary TJA on postoperative pain, opioid consumption, and complications.[22,23] Given the differences in outcome measures utilized and the timepoints at which were measured at no meta-analyses could be performed.

Both studies evaluated postoperative opioid consumption after administering an intraoperative opioid during primary TJA. They both found that administering an intraoperative opioid reduced postoperative opioid consumption compared to placebo within the first 72 hours after surgery.[22,23]  These two studies also evaluated VAS pain scores and found no difference between patients who received an intraoperative opioid and placebo within the first 72 hours postoperatively. Similarly, there was no difference in the rates of nausea or vomiting between patients who received intraoperative opioids and those who received placebo. However, it is the opinion of the workgroup that when combined with other opioids administered preoperatively or postoperatively, opioids administered during surgery may increase the risk of complications including respiratory depression and sedation. Given there is not significant evidence on the risk of complications associated with intraoperative opioid use we downgraded this recommendation from a strong recommendation to a moderate recommendation. 


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