The majority of patients undergoing total knee replacement(TKR) rely on opioids for postoperative analgesia. These medications have undesirable side effects and potential for abuse and addiction. The aim of this cohort study is to determine the incidence rate of patients who are able to maintain a low dose opioid regimen after TKR with the use of a multimodal approach that includes intraoperative auricular acupuncture protocol.
This is a prospective cohort study to assess the feasibility of patients to undergo TKR while adhering to a low-dose opioid regimen by using a multimodal analgesic approach that includes intraoperativeauricular acupuncture. We hypothesize that it will be feasible to maintain a low-dose opioid regimen during TKR while followingthe intraoperative auricular acupuncture protocol, and that patients will be satisfied with their pain control with a low incidence of adverse events.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
41
Ipsilateral Auricular Trauma Protocol (ATP) acupuncture at eight ear points (Hypothalamus, Amygdala, Hippocampus, Prefrontal Cortex, Point Zero, Shen Men, Insula, Vagus) with 30Hz electrostimulation at two of those points (Shen Men and Hypothalamus). Acupuncture needles will be left in place and stimulated for 60 min and then removed
Ipsilateral Auricular Trauma Protocol (ATP) acupuncture at eight ear points (Hypothalamus, Amygdala, Hippocampus, Prefrontal Cortex, Point Zero, Shen Men, Insula, Vagus) with 30Hz electrostimulation at two of those points (Shen Men and Hypothalamus).
Hospital for Special Surgery
New York, New York, United States
Low-dose Opioid Regimen Adherence
The number of patients who maintain a low-dose opioid regimen (15 pills or less of 5mg oxycodone or 112.5 OME \[oral morphine equivalents\]) from postoperative day (POD) 0 to POD 30 throughout their Total Knee Replacement.
Time frame: postoperative day 0 to postoperative day 30
Total Opioid Consumption
Postoperative opioid consumption measured in oral morphine equivalents (OME) at various timepoints
Time frame: post anesthesia care unit (PACU), postoperative day (POD) 1, POD7, POD14, POD30
Numerical Rating Scale (NRS) Pain Scores at Rest and With Movement
Numerical Rating Scale (NRS) pain scores at rest and with movement. NRS pain is measured from 0 to 10, with 0 being the no pain whatsoever and 10 being the worst pain imaginable.
Time frame: post anesthesia care unit (PACU), postoperative day (POD) 1, POD7, POD14, POD30
Duration of Neuraxial Anesthesia in Hours
Duration of neuraxial anesthesia is defined as number of hours between anesthesia start time to anesthesia stop time.
Time frame: postoperative day 1
Deviation From Prescribed Oral Pain Regimen
Tracking the number of patients that received different oral pain main medication, including the need for rescue medications by postoperative day 30
Time frame: Postoperative day 30
Number of Participants With Side Effects on POD1 and During the PACU Stay
Incidence of nausea, vomiting, pruritus (itching), and constipation. These are reported by the patient in the PACU and on postoperative day 1
Time frame: PACU, Postoperative day 1
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Postoperative Range of Motion
Postoperative range of motion measured at the 6 week surgeon office visit. This is being measured by either the physician or their PA and is a score that is achieved by adding extension and flexion together. It is measured in degrees. (example: flexion: 118 + extension:1 = score: 119)
Time frame: 6 weeks postoperative (surgeon office visit)
Tourniquet Time
Duration of time the tourniquet is inflated intraoperatively. Measured in minutes
Time frame: Intraoperatively