Background & Aims
Total hip and knee arthroplasty are among the most common elective surgical procedures performed worldwide. A significant proportion of patients awaiting hip or knee arthroplasty are prescribed opioid analgesics despite little evidence for benefit and an increased risk of harms. Preoperative opioid use has been linked with worse postoperative outcomes including worse pain, physical function, and longer length of hospital stay after surgery. No studies have implemented an intervention to taper opioids before arthroplasty. This trial aimed to establish the efficacy of an intervention on preoperative reduction of opioid use before elective hip or knee arthroplasty compared to usual practice.
Methods
This was a multicentre, randomized clinical trial with a usual care control arm. Participants were randomized before surgery in a 1:1 ratio in permuted blocks of two and four to the intervention or control (usual care) arm. Participants were recruited from surgery waitlists of eight metropolitan or regional hospitals in Australia. Participants aged 18 years or older who were undergoing primary elective total hip or knee arthroplasty and using opioid analgesics and were able to speak and read English were included. Participants randomized to the intervention group received a telehealth pharmacist-led service to taper participants’ opioid dose before surgery. Data were collected 3 months prior to surgery, 1 to 3 days preoperatively and 3 months after hospital discharge. The primary outcome was the proportion of participants who tapered 50% or more of their baseline daily opioid dose before surgery. Analyses were performed in accordance with an intention-to-treat principle.
Results
In total, 70 participants were recruited (mean [standard deviation] age, 56 [12] years, 38 [54%] female), including 35 participants in the intervention group and 35 participants in the control group. Baseline characteristics of the groups were similar. A significantly greater proportion of participants randomised to receive the opioid tapering intervention reduced their preoperative opioid dose by at least 50% of their baseline daily opioid dose compared with the usual care arm (27/35 [90%] vs. 5/35 [7%]; p < 0.001). At the three-month postoperative follow-up, significantly fewer participants in the intervention group remained on opioids compared with the control arm (6/28 [21%] vs. 14/23 [64%]; p = 0.02).
Conclusions
A pharmacist-led preoperative opioid tapering intervention is an effective strategy for the reduction of preoperative and postoperative opioid use among patients undergoing total hip and knee arthroplasty. Further research to explore the generalisability of this intervention across different contexts are warranted.
References
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Presenting Author
Shania Liu
Poster Authors
Topics
- Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science