Effect of a Pre-operative Internet-based Educational Video on Post Operative Opioid Consumption

N/AActive Not RecruitingNCT05202080

Sunnybrook Health Sciences Centre220 enrolled

Overview

One of the most challenging issues in modern medicine is the current opioid epidemic. Given the association between opioid use after surgery and the development of opioid addiction, an essential goal of the medical community should be to develop strategies aimed at instructing the safe use of opioids. In addition, instructions on how to use non-opioid painkillers and exercises and techniques to better cope with pain can be used to reduce the patients opioid requirements after surgery. This study aims to evaluate the effect of providing an online educational video presentation to patients prior to surgery. This will be a 30 minute video which will provide the study participants with instructions on how best to use their opioid and non-opioid medication for pain and also teach the study participants exercises and techniques to better cope with their pain. This intervention will be used with a view to reduce the amount of opioids used by patients following hip or knee replacement surgery. Participants will be followed during their immediate phase after surgery to determine how much pain killers the participants have used and at six weeks the participants will be asked to return their unused opioids to see how much the participants have used in total.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

220

Conditions

Patient Empowerment

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients must be adults (\> 18 years of age) undergoing knee or hip arthroplasty. * Patients will be ASA 1-3 undergoing elective surgery. * English speaking patients with internet and computer access at home will be included. * Patients with pre-existing psychological conditions who receive either pharmaceutical or talk-based therapy will be included. * Patients must meet a minimum cognitive capacity to understand the instructions for the Opioid Counseling and Pain Coping Skills presentation. This will be assessed by the administration of the Montreal Cognitive Assessment during screening (MoCA), whereby a minimum score of 18 will be required to meet inclusion into the study. Exclusion Criteria: * Significant cognitive impairment. * Chronic pain, long-term opioid therapy * Renal replacement therapy * Standing opioid requirements * Neuropathic pain * Fractures requiring emergency surgery * End stage cardiac or respiratory disease * Severe hepatic dysfunction, * Patients with severe psychiatric disorders * Vision loss * Allergy to local anesthesia. * Patients who refuse to consent to neuraxial anesthesia and/or peripheral nerve blocks will also be excluded.

Outcomes

Primary Outcomes

Post operative opioid consumption

Total opioid consumption during the first 72 hours following THA or TKA surgery, measured in oral morphine equivalents.

Time frame: From surgery until 72 hours postoperatively.

Secondary Outcomes

Postoperative Pain

Using the Visual Analog Scale (VAS) for Pain Assessment from 0 to 10 with 0 being no pain and 10 being extreme pain.

Time frame: On postoperative days 1/2/3, and 1- and 6-week follow-up.

Length of hospital stay

Length of Stay from day of hospital admission to day of hospital discharge.

Time frame: From day of admission until 72 hours postoperatively.

Time to first opioid demand dose

The number of hours from the time of surgery to the participants requesting their first opioid dose, either in the post-anesthesia care unit or the ward.

Time frame: In the first 24 hours after surgery.

Post-operative complication rate

The incidence of postoperative complications, including events possibly related to opioid consumption.

Time frame: 24 hours after surgery, and 1/6 week follow-ups.

Total opioid consumption at 6-week follow-up

The total opioid consumption, reported at the 6 week follow-up.

Time frame: 6 weeks after surgery.

Need for rescue opioid breakthrough therapy

The need for rescue opioid breakthrough therapy in the first 24 hours after surgery, assessed as a binary (yes/no) outcome.

Time frame: From surgery until 24 hours postoperatively.

Participant Compliance

Participant compliance, defined as whether or not participants in the experimental group viewed the study video.

Time frame: Day of surgery

Participant satisfaction at baseline

Participants' satisfaction with the study video, assessed using a questionnaire. The questionnaire contains seven statements regarding the acceptability of the study video, with responses on a 5-point Likert scale from "highly agree" to "highly disagree." Only participants in the experimental group complete the satisfaction questionnaire.

Time frame: Baseline (up to 1 week before surgery).

Participant satisfaction at 1 week

Time frame: 1 week after surgery.

Participant satisfaction at 6 weeks