Managing Joint Replacement Post-Op Opioid Use

Managing Joint Replacement Post-Op Opioid Use

William P. Barrett, MD

An article published in JBJS Feb. 2018 by Sabatino et al documented excess opioid prescribing for patients undergoing THA/TKA procedures. They noted that post-op pain management for several major orthopedic procedures accounts for a substantial portion of opioid medications prescribed in the US. The authors evaluated the prescribing habits and patient utilization following elective orthopedic procedures at Dartmouth Hitchcock Medical Center in New Hampshire.

They evaluated prescribing data for 1,199 orthopedic procedures during 2015, the majority of which were hip and knee replacement procedures. They noted that 60% of the time, excess pain pills were prescribed i.e. patients did not use all the medication. This accounted for 43,000 opioid pills prescribed but not used. There was a very large range in pills prescribed 30 – 560.

The authors recommend that orthopedic surgeons decrease the number of opioid pills prescribed to help with the opioid crisis facing the U.S. We have continued to refine our pain management protocols emphasizing non-narcotic options. Insurance companies have weighed in, limiting the number of opioid pills that can be prescribed at discharge after hip and knee replacement. This will result in some increased patient inconvenience as patients or their family will have to drive to our office for refills. We all have to do our part to help with this national crisis.

Dr. Barrett is an orthopedic surgeon who performs over 500 joint replacement surgeries annually. For more information about total hip and knee replacements, contact Proliance Orthopedic Associates at 425.656.5060.