SUPPORTING LITERATURE
Atwood et al. 2021 (Level 3 evidence)
- DOI: http://doi.org/10.1016/j.artd.2020.12.021
- 61 patients undergoing THA were prescribed 84 doses of 5mg oxycodone and were surveyed at 2 weeks and 6 weeks postoperatively regarding consumption.
- At 2 weeks, an average of 28.1 doses were taken. At 6 weeks, an average of 31.9-33.1 doses were taken.
Cunningham et al. 2021 (Level 3 evidence)
- DOI: https://doi.org/10.1186/s13011-021-00410-w
- Descriptive study using a national database to compare perioperative opioid filling volumes and rates in 487,942 patients undergoing primary total hip arthroplasty between 2010-2018.
- Initial opioid filling volume has not changed; however, the overall cumulative opioid filling volume has decreased 26% since 2010.
- States with legislation had larger magnitude of reductions in both initial and cumulative filling volume compared to states without legislation.
Zhao & Davis 2019 (Level 4 evidence)
- DOI: https://doi.org/10.1016/j.ijnurstu.2019.06.010
- Literature review on patient recovery after total hip arthroplasty
- Data collected by 26 September 2017- 12 March 2018 and included 605 articles collected from PubMed, Embase, and CINAHL.
- Non-opioid interventions such as acetaminophen, nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, gabapentinoids, ketamine, peripheral nerve blocks, and local infiltration analgesia benefit patients after total hip arthroplasty for pain management.
- Recommend non-opioid interventions for effective pain management following total hip arthroplasty.
Nouraee et al. 2021 (Level 3 evidence)
- DOI: http://doi.org/10.1097/JHQ.0000000000000309
- Analyzed data from 3,142 patients undergoing total hip arthroplasty at five institutions between 23 August 2018- 23 August 2019.
- Mean inpatient opioids prescribed = 48.4 pills. Mean consumed = 27.3 pills
- Mean outpatient opioids prescribed = 40.9 pills. Mean consumed = 19.9 pills
Dattilo et al. 2020 (Level 3 evidence)
- DOI: https://doi.org/10.1016/j.arth.2020.04.089
- Retrospective analysis of patients undergoing total hip and total knee arthroplasty at a single institution between October 2017- August 2019
- (THA) Mean opioids consumed by opioid naive patients = 17 ± 15 pills.
- Postoperative prescription of 45 pills was sufficient for nearly 90% of THA patients.
- THA patients consumed less opioids and for a shorter duration than TKA patients.
Roberts et al. 2020 (Level 3 evidence)
- DOI: https://doi.org/10.1016/j.arth.2019.08.036
- Analyzed data from 723 opioid-naive patients at 7 hospitals in Michigan who underwent TKA (426 patients) and THA (297 patients). Patients were contacted within 3 months after surgery.
- Mean OME prescribed for TKA = 632mg. Mean consumed = 416mg.
- Mean OME prescribed for THA = 584mg. Mean consumed = 285mg.
- Recommended postoperative prescription = 50 pills for TKA and 30 pills for THA.
Tollemar et al. 2022 (Level 3 evidence)
- DOI: 10.1016/j.arth.2022.10.038
- Retrospective analysis of 120,889 opioid-naive patients who underwent THA and TKA between Jan 2015 and Nov 2019 and looked at prescription fill rates. – 30-day prescription fill rate for TKA = 59.6%
- 30-day prescription fill rate for THA = 26.1% – Odds of refill decreased by 2% (for THA) and 3% (for TKA) for every 75 OME added to the initial prescription (marginal increase that supports prescribing smaller amounts due to the small risk of needing refills)
Hannon et al. 2019 (Level 1 Evidence)
- DOI: 10.1016/j.arth.2019.01.065
- RCT prescribing either 30 (161 patients) or 90 (143 patients) 5mg OxyIR pills at discharge after undergoing THA and TKA.
- No difference in MME consumed at 90 days. No difference in pain scores at 30 days or outcome scores at 6 weeks.
MARCQI 2020 (Level 4 Evidence)
- marcqi.org
- Discuss alternatives and opioid-weaning strategies with patients
- Avoid prescribing benzodiazepines with opioids, only prescribe one opioid at a time, and prescribe naloxone for high-risk patients
- Initial prescriptions should be less than 240 OME (for THA) or 320 OME (for TKA). Supplement with acetaminophen.
