Six‐year trends in postoperative prescribing and use of multimodal analgesics following total hip and knee arthroplasty: A single‐site observational study of pain management

Abstract

Background: Guidelines for acute postoperative pain management recommend administering analgesics in multimodal combination to facilitate synergistic benefit, reduce opioid requirements and decrease side-effects. However, limited observational research has examined the extent to which multimodal analgesics are prescribed and administered postoperatively following joint replacement. Methods: In this longitudinal study, we used three-point prevalence surveys to observe the 6-year trends in prescribing and use of multimodal analgesics on the orthopaedic wards of a single Australian private hospital. We collected baseline postoperative data from total hip and knee arthroplasty patients in May/June 2010 (Time 1, n = 86), and follow-up data at 1 year (Time 2, n = 199) and 5 years (Time 3, n = 188). During the follow-up, data on prescribing practices were presented to anaesthetists. Results: We found a statistically significant increase in the prescribing (p < 0.001) and use (p < 0.001) of multimodal analgesics over time. The use of multimodal analgesics was associated with lower rest pain (p = 0.027) and clinically significant reduction in interference with activities (p < 0.001) and sleep (p < 0.001). However, dynamic pain was high and rescue opioids were likely under-administered at all time points. Furthermore, while patients reported high levels of side-effects, use of adjuvant medications was low. Conclusions: We observed significant practice change in inpatient analgesic prescribing in favour of multimodal analgesia, in keeping with contemporary recommendations. Surveys, however, appeared to identify a clinical gap in the bedside assessment and management of breakthrough pain and medication side-effects, requiring additional targeted interventions. Significance: Evaluation of 6-year trends in a large Australian metropolitan private hospital indicated substantial growth in postoperative multimodal analgesic prescribing. In the context of growing global awareness concerning multimodal analgesia, findings suggested diffusion of best-evidence prescribing into clinical practice. Findings indicated the effects of postoperative multimodal analgesia in real-world 108 | KHAW et Al. How to cite this article: Khaw D, Bucknall T, Considine J, et al. Six-year trends in postoperative prescribing and use of multimodal analgesics following total hip and knee arthroplasty: A single-site observational study of pain management.

Trends in Opioid Use during Hospitalization following Revision Total Hip Arthroplasty from 2016 to 2021

“…In a recent study by Khaw et al, in which physicians were presented guidelines for multimodal pain management prior to TJA procedures and follow-up visits, the proportion of unimodal prescribing in THA patients decreased from 53.7 to 6% over a 6-year period. 7 The results of this study demonstrate a similar transition from unimodal to multimodal consumption following MPMP implementation. Interestingly, the downward trend in opioid use seen in our study was not consistent over the study period, with a minor increase observed in 2020 (►Fig.…”

“…6 This acute pain predisposes patients to postsurgical complications such as decreased ambulation and mobilization, which may in turn lead to chronic pain and an overall reduced clinical outcome. [7][8][9] The extent of postoperative complications may be even more profound in patients undergoing rTHA, necessitating the study of additional methods of pain management. 10,11 Opioids are the most commonly utilized method of pain management in the postoperative recovery period following THA.…”

“…12,[16][17][18][19][20][21][22] While many studies have evaluated the efficacy of multimodal pain management in treating pain following joint arthroplasty, 18,19,21,22 few have investigated MPMPs' effects on opioid prescribing over time. 7 In this study, we investigated the trends in opioid use following hospitalization for rTHA procedures from 2016 to 2021 following implementation of an MPMP. We predicted that opioid consumption would decrease consistently throughout this study in conjunction with the use of this MPMP.…”