It is well recognized that a multimodal analgesia program targeting multiple pain pathways, is more effective for controlling pain during the hospital stay and in the acute postoperative period than monotherapy-based regimens, such as opioids only. This multimodal analgesic regimen also leads to reduce opioid consumption and its related side effects after hip and knee joint replacement procedures. One potential strategy to reduce the use of opioids after TKA is to administer a prolonged oral multimodal pain regimen that targets multiple pain pathways in the post hospital discharge period. This can be equal or more effective than the regimen of opioid prescriptions used after TKA. To the best of our knowledge, there have been no studies conducted that directly examine the effect of prolonged multimodal pain regimen after hospital discharge in primary TKA patients. PURPOSE: 1. To determine whether a prolonged multimodal pain regimen after discharge from primary TKA can provide equivalent or better pain control while reducing opioid consumption and, subsequently, opioid-related side effects. 2. To determine whether patient expectations and routine opioid prescription practices at the time of discharge from primary TKA impacts opioid consumption.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
216
Patients are given, for up to 4 weeks, Oxycodone 5m PRN every four hours (up to 30 tablets)
Patients are given, for up to 4 weeks, Tramadol 50mg PRN every 6 hours (up to 30 tablets)
Tylenol 1000 mg: take as needed every 8 hours
Meloxicam 15 mg as need once per day
•Gabapentin 200 mg with morning and evening Tylenol dose
Metaxalone 800mg TID
Esomeprazole 20mg daily
Rothman Institute
Philadelphia, Pennsylvania, United States
Post-operative pain
Measured via Visual Analog scale (0-100mm)
Time frame: Postsurgery days 1-30
Opioid related side effects
Severity measured via Visual Analog scale (0-100mm)
Time frame: post-surgery days 1-30
opioid consumption
morphine milligram equivalent
Time frame: post-surgery weeks 1-4
opioid consumption
number of pills consumed
Time frame: post-surgery weeks 1-4
number of opioid refills
number of times subjects asked to have an opioid prescription refilled during post-operative period
Time frame: post-surgery weeks 1-4
90 day complications
collection of all post-operative medical complications within the first 90 days after surgery
Time frame: post-surgery 90 days
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