Opioid Use Following TJA Surgery
Prescribing lower quantities of opioid pills at discharge may lead to equivalent patient reported outcomes, pain relief, reduced opioid consumption, and fewer unused opioid pills after TJA.
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

           One high quality study evaluated the influence of the number of opioid pills prescribed at discharge after TJA on patient reported outcome scores, pain control, and opioid consumption after TJA.[33] In their prospective blinded randomized controlled trial, Hannon et al. found that patients who received 30 oxycodone immediate release pills (OxyIR) as opposed to 90 pills had equivalent patient reported outcome scores and significantly fewer unused pills at 6 weeks postoperatively. Patients who received 90 OxyIR pills had on median 73 unused pills while patients who received 30 OxyIR pills had on median 15 unused pills. Opioid consumption within 6 weeks after surgery was equivalent between the two groups, however regression analysis determined that being prescribed 90 OxyIR pills was independently associated with taking more oxycodone pills. Given the risks associated with diversion of unused opioid pills, it is the opinion of the workgroup that patients be prescribed the fewest number of opioid pills possible without jeopardizing pain control and clinical outcomes after TJA. 


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