Hip surgery: minimal-opiate multimodal regimen improves pain control

  • Fleischman AN & al.
  • J Am Coll Surg
  • 05.06.2019

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Patients who underwent surgery for total hip replacement (THR) whose postoperative pain was managed with a multimodal analgesic regimen that included fixed-schedule doses of acetaminophen, meloxicam, and gabapentin and only a 2-day supply of prescription opioids reported superior pain relief than those managed with the traditional approach of as-needed opiates.

Why this matters

  • Previously published research suggests that the demand for primary THR in the United States is estimated to grow by 174% by 2030.

Study design

  • Parallel-group, cluster-randomized OPIOID study of 235 patients who, after undergoing THR, were randomly assigned to:
    • multimodal analgesic regimen (fixed-schedule doses of acetaminophen, meloxicam, and gabapentin)+2-day opiate supply;
    • multimodal analgesic regimen+2-week opiate supply; or
    • acetaminophen+2-week opiate supply (control group).
  • Funding: None disclosed.

Key results

  • At 30 days, visual analog scale (VAS) pain scores were significantly lower with multimodal analgesia vs control group:
    • 2-day opiate group: coefficient, −0.81 (P=.003).
    • 2-week opiate group: coefficient, −0.61 (P=.021).
  • VAS pain scores were not significantly different between the 2 multimodal analgesic groups.
  • Multimodal analgesic with 2-day opiate supply had significantly lower:
    • daily morphine equivalents vs 2-week supply (coefficient, −0.46; P=.002) and control group (coefficient, −0.77; P<.001 and>
    • composite opioid-related symptom distress scale score vs control group (P=.005).

Limitations

  • Patient-reported opioid consumption.

Coauthored with Antara Ghosh, PhD