Opioid use prior to total hip arthroplasty leads to worse clinical outcomes
- 27 February 2014
- journal article
- research article
- Published by Springer Science and Business Media LLC in International Orthopaedics
- Vol. 38 (6), 1159-1165
- https://doi.org/10.1007/s00264-014-2298-x
Abstract
The purpose of this study was to compare the clinical outcomes of patients undergoing total hip arthroplasty (THA) who had been using narcotic medications prior to surgery to those who had not used them. Fifty-four patients (62 hips) who had required opioid analgesia for hip pain in the three months prior to THA were compared to a matched group of opioid-naïve patients. Narcotic consumption was converted to a standardized morphine equivalent dose and compared between both groups of patients during their hospital stay, after six weeks, and at final follow-up. Other outcome measures included clinical outcome scores and the proportion of patients remaining on narcotic pain medication at final follow-up. The narcotic group required significantly higher total daily opioid doses as inpatients had a longer hospital stay and a higher proportion of patients who remained on opioids at six weeks and at final follow-up. Of the patients who were taking opioids pre-operatively, 81 % were able to wean off opioids at final follow-up. At a mean post-operative follow-up of 58 months (range, 24–258 months), Harris hip scores were lower in the narcotic group, with a mean of 84 compared to 91 points in the matching group. However, in both cohorts, there were significant improvements in Harris hip scores compared to pre-operative outcomes. Patients who use narcotics prior to total hip arthroplasty may be more likely to suffer from opioid-induced hyperalgesia after surgery and have worse clinical outcomes. When possible, efforts should be made to use other modes of analgesia or wean patients from their use prior to total hip arthroplasty.Keywords
This publication has 36 references indexed in Scilit:
- The Efficacy of Periarticular Multimodal Drug Infiltration in Total Hip ArthroplastyClinical Orthopaedics and Related Research, 2010
- Lessons Learned with Extended-release Epidural Morphine after Total Hip ArthroplastyClinical Orthopaedics and Related Research, 2010
- Age, gender, obesity, and depression are associated with patient-related pain and function outcome after revision total hip arthroplastyClinical Rheumatology, 2009
- Higher Opioid Doses Predict Poorer Functional Outcome in Patients with Chronic Disabling Occupational Musculoskeletal DisordersJournal of Bone and Joint Surgery, 2009
- Opioids and the Management of Chronic Severe Pain in the Elderly: Consensus Statement of an International Expert Panel with Focus on the Six Clinically Most Often Used World Health Organization step III Opioids (Buprenorphine, Fentanyl, Hydromorphone, Methadone, Morphine, Oxycodone)Pain Practice, 2008
- OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelinesOsteoarthritis and Cartilage, 2008
- Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part IArthritis & Rheumatism, 2007
- Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part IIArthritis & Rheumatism, 2007
- Equianalgesic Dose Ratios for Opioids: A Critical Review and Proposals for Long-Term DosingJournal of Pain and Symptom Management, 2001
- Postoperative pain management — beyond basicsCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1996