Opiate-sparing analgesia after discharge from total hip

Editor's Note

Multimodal analgesia with minimal opiates improved pain control and significantly decreased opiate use and opiate-related adverse effects after discharge from elective total hip replacement surgery, finds this study.

The 235 patients analyzed received one of three discharge pain regimens:

• Group A: scheduled-dose multimodal analgesia (ie, acetaminophen, meloxicam, gabapentin) with a minimal opiate supply
• Group B: scheduled-dose multimodal analgesia with a traditional opiate supply
• Group C: traditional PRN opiate regimen alone.

Daily pain was significantly lower in Group A and B, relative to Group C. Daily opiate use in Group A and B was lower than Group C, and opiate use for Group A was lower than Group B. Duration of opiate use was significantly shorter for Group A (1.14 weeks) and Group B (1.39 weeks), compared with Group C (2.57 weeks).

Fewer opiate related symptoms (most commonly fatigue) occurred in Group A than Group C, but Groups B and C were not significantly different. The multimodal regimens improved satisfaction and sleep, and there were no differences in hip function or adverse events.

The researchers concluded that it is time to rethink the reliance on opiates after elective hip replacement surgery.