Primary Knee
Efficacy of Opioids in Preemptive Multimodal Analgesia for Total Knee Arthroplasty: A Prospective, Double-Blind, Placebo-Controlled, Randomized Trial

https://doi.org/10.1016/j.arth.2022.08.001Get rights and content

Abstract

Background

Preemptive multimodal analgesia is a commonly used technique to control pain following total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of pre-emptive opioids for pain management in patients who underwent TKA.

Methods

In this prospective, double-blind, placebo-controlled, randomized trial, 100 patients who underwent TKA at our hospital were randomized to the oxycodone or control group. At 2 hours before surgery, patients in the oxycodone group received 400 mg celecoxib, 150 mg pregabalin, and 10 mg extended-release oxycodone hydrochloride. Patients in the control group received 400 mg celecoxib, 150 mg pregabalin, and placebo. The primary outcome was postoperative consumption of morphine hydrochloride as rescue analgesia. Secondary outcomes were time to first rescue analgesia, postoperative pain assessed by the visual analogue scale, functional recovery assessed by range of knee motion and ambulation distance, time until hospital discharge, indicators of liver function, and complication rates.

Results

The 2 groups were similar in mean postoperative 0 to 24 hour morphine consumption (11.4 mg for control versus 12.4 mg for oxycodone group, P = .419) and mean total morphine consumption (18.2 versus 19.8 mg, P = .227). There were no statistical differences in secondary outcomes.

Conclusions

In our study, preemptive opioid administration did not provide clinical benefits over placebo. Orthopaedic surgeons should consider not using pre-operative opioids in patients undergoing TKA.

Section snippets

Materials and Methods

The study was designed as a prospective, double-blind, placebo-controlled, randomized trial and approved by the Clinical Trials and Biomedical Ethics Committee of our institution. Written informed consent was obtained from all participants. This study was prospectively registered on Chinese Clinical Trial Registry (identification number: ChiCTR2100044876) on March 31, 2021. This study was conducted between April 9, 2021 and February 19, 2022.

Primary Outcome

The 2 groups were similar in mean postoperative 0 to 24 hour morphine consumption (11.4 mg for control versus 12.4 mg for oxycodone group, P = .419) and total morphine consumption (18.2 versus 19.8 mg, P = .227; See Table 2). The proportions of patients receiving rescue analgesia were similarly high between the control group (44 cases, 88.0%) and the oxycodone group (47 cases, 94.0%).

Secondary Outcomes

Time to first rescue analgesia did neither differ between the 2 groups (See Table 2 and Fig. 2), nor did

Discussion

Here we present the results of a clinical trial evaluating the efficacy of preemptive opioids for pain management in patients who underwent TKA. The most important finding of our study is that adding opioids to pre-operative preemptive multimodal analgesia does not appear to reduce postoperative morphine consumption or improve pain relief. Thus, orthopaedic surgeons may consider not using pre-operative opioids in patients undergoing TKA.

Previous studies have reported that preemptive multimodal

Acknowledgments

We want to express our sincere appreciation for all the patients that joined this study. This study was funded by 1.3.5 Project of Sichuan University West China Hospital, grant no. ZYJC18040.

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  • Cited by (0)

    Qiuru Wang and Wanli Zhang contributed equally to this work and should be regarded as first co-authors.

    No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2022.08.001.

    Ethical review committee statement: This study was approved by the Clinical Trials and Biomedical Ethics Committee of Sichuan University West China Hospital, and written informed consents were obtained from all participants.

    Trial registration: This study was prospectively registered on Chinese Clinical Trial Registry (identification number: ChiCTR2100044876) on March 31, 2021.

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