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Poppies / Source: Wikimedia Commons and the U.S. Department of Justice

TKA: Preop Opioids Involve Postop Mess

Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, January 30th, 2018

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Working with total knee arthroplasty (TKA) patients, Mayo Clinic researchers set out to see how preoperative opioid use would affect opioid prescriptions, refills, and clinical outcomes.

To do so, they performed a retrospective review of 53 patients who took opioids before surgery. Their work, “Patients at Risk: Preoperative Opioid Use Affects Opioid Prescribing, Refills, and Outcomes after Total Knee Arthroplasty,” appears in the January 15, 2018 edition of the Journal of Arthroplasty.

The authors wrote, “The average total MED [morphine equivalent dose] prescribed at discharge was 1,248 mg, ranging from 0 to 5,600 mg. the average daily MED used prior to discharge was greater in the preoperative opioid group compared to the opioid naïve group.”

“The preoperative opioid group and opioid naïve groups differed in terms of refills, persistent opioid use, postoperative KSS [Knee Society Score], and manipulations under anesthesia [MUA]. Preoperative tramadol users had the same risk of refills, persistent opioid use, reduced KSS scores, and MUA as those taking other opioids.”

Michael J. Taunton, M.D., with Orthopedic Surgery at Mayo Clinic in Rochester, Minnesota, and co-author on the study, told OTW, “The U.S. is currently in the middle of an opioid epidemic. This study found that patients that took opioids before total knee arthroplasty required more refills, were more likely to remain on opioids, and required more manipulations under anesthesia than opioid naïve patients.”

“Interestingly, these risks extended to preoperative tramadol users. We recommend that patients consider weaning off all opioids, including tramadol, prior to total knee arthroplasty to optimize their outcomes.”

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One Response to “TKA: Preop Opioids Involve Postop Mess”

  1. Mark Scioli MD says:

    This is ridiculous when many (if not most), of these patients have have shoulder arthritis, spinal stenosis, hip disease etc. They can’t sleep at night not because of their knee, but because of their other pathological pain. There is no way they can get through their day without opioids and have reasonable function. In my practice, the patient with only knee arthritis and nothing else is rare indeed…While I have no issue with the premise of the article, it is disingenuous not to recognize the thousands of patients who require opioids because of other conditions who fall out of this perfect little paradigm.

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