Opioid-free postoperative pain management in total knee and hip arthroplasty: A scoping review
Purpose: Recognition of opioid misuse and related complications following total knee arthroplasty (TKA) and total hip arthroplasty (THA) has subsequently prompted the use of opioid alternatives for perioperative pain management. Multimodal opioid-sparing regimens have emerged to reduce postoperative...
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Elsevier
2025-04-01
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| Series: | Journal of Orthopaedic Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773157X24001498 |
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| author | Olivia K. Blaber Patrick Ioffreda Jenna Adalbert Irfan A. Khan Jess H. Lonner |
| author_facet | Olivia K. Blaber Patrick Ioffreda Jenna Adalbert Irfan A. Khan Jess H. Lonner |
| author_sort | Olivia K. Blaber |
| collection | DOAJ |
| description | Purpose: Recognition of opioid misuse and related complications following total knee arthroplasty (TKA) and total hip arthroplasty (THA) has subsequently prompted the use of opioid alternatives for perioperative pain management. Multimodal opioid-sparing regimens have emerged to reduce postoperative opioid consumption, while opioid-free approaches aim to eliminate it. The purpose of this scoping review was to explore the effectiveness of opioid-free postoperative pain management regimens for total joint arthroplasty (TJA). Methods: Searches were conducted in PubMed [MEDLINE], Scopus, Cochrane Library, Clinical Trials Website [U.S.], Europe PMS, and LILAC databases for randomized controlled trials, prospective nonrandomized trials, and retrospective studies reporting opioid-free TKA or THA from January 1st, 1985 to January 31st, 2022. Studies with postoperative opioids or unclear postoperative regimens were excluded. For included articles, the following data were extracted: study design, country, year, surgery type, population demographics, anesthesia type, preoperative analgesia, intraoperative analgesia and anesthesia, postoperative analgesia, and outcome measures. Results: Searches identified 3039 studies, and of those, 55 were eligible. 32 articles evaluated TKA, 22 evaluated THA, and one evaluated both. Most studies were performed in Asia (n = 33) and Europe (n = 18). All studies reported on outcomes in the first 24 hours, 38 studies in the intermediate postoperative phase, and 9 studies post-discharge. Most TKA studies (n = 20) reported use of at least one systemic analgesic and 18 employed postoperative peripheral nerve blocks. Neuraxial analgesia (epidural or spinal block) was the predominant form of postoperative analgesia in THA (n = 10), followed by peripheral nerve blocks (n = 7), and systemic analgesia (n = 7). NSAIDs were the most frequently reported rescue analgesic used in TKA and THA (n = 23, n = 16). All 16 studies comparing opioid-free to opioid-based interventions reported equivalent or superior pain relief in the opioid-free group. Conclusion: Post-arthroplasty pain may be managed effectively without opioids in select patients. Our findings emphasize the importance of future clinical studies exploring opioid-free regimens, to optimally control post-TJA pain. |
| format | Article |
| id | doaj-art-2935d892c0674cb58c7e2eadd17e46d3 |
| institution | OA Journals |
| issn | 2773-157X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Orthopaedic Reports |
| spelling | doaj-art-2935d892c0674cb58c7e2eadd17e46d32025-08-20T02:07:13ZengElsevierJournal of Orthopaedic Reports2773-157X2025-04-014110045410.1016/j.jorep.2024.100454Opioid-free postoperative pain management in total knee and hip arthroplasty: A scoping reviewOlivia K. Blaber0Patrick Ioffreda1Jenna Adalbert2Irfan A. Khan3Jess H. Lonner4Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USACorresponding author. 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA.; Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USARothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USARothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USARothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USAPurpose: Recognition of opioid misuse and related complications following total knee arthroplasty (TKA) and total hip arthroplasty (THA) has subsequently prompted the use of opioid alternatives for perioperative pain management. Multimodal opioid-sparing regimens have emerged to reduce postoperative opioid consumption, while opioid-free approaches aim to eliminate it. The purpose of this scoping review was to explore the effectiveness of opioid-free postoperative pain management regimens for total joint arthroplasty (TJA). Methods: Searches were conducted in PubMed [MEDLINE], Scopus, Cochrane Library, Clinical Trials Website [U.S.], Europe PMS, and LILAC databases for randomized controlled trials, prospective nonrandomized trials, and retrospective studies reporting opioid-free TKA or THA from January 1st, 1985 to January 31st, 2022. Studies with postoperative opioids or unclear postoperative regimens were excluded. For included articles, the following data were extracted: study design, country, year, surgery type, population demographics, anesthesia type, preoperative analgesia, intraoperative analgesia and anesthesia, postoperative analgesia, and outcome measures. Results: Searches identified 3039 studies, and of those, 55 were eligible. 32 articles evaluated TKA, 22 evaluated THA, and one evaluated both. Most studies were performed in Asia (n = 33) and Europe (n = 18). All studies reported on outcomes in the first 24 hours, 38 studies in the intermediate postoperative phase, and 9 studies post-discharge. Most TKA studies (n = 20) reported use of at least one systemic analgesic and 18 employed postoperative peripheral nerve blocks. Neuraxial analgesia (epidural or spinal block) was the predominant form of postoperative analgesia in THA (n = 10), followed by peripheral nerve blocks (n = 7), and systemic analgesia (n = 7). NSAIDs were the most frequently reported rescue analgesic used in TKA and THA (n = 23, n = 16). All 16 studies comparing opioid-free to opioid-based interventions reported equivalent or superior pain relief in the opioid-free group. Conclusion: Post-arthroplasty pain may be managed effectively without opioids in select patients. Our findings emphasize the importance of future clinical studies exploring opioid-free regimens, to optimally control post-TJA pain.http://www.sciencedirect.com/science/article/pii/S2773157X24001498Opioid-freePostoperative painMultimodal pain regimenTotal joint arthroplastyTotal hip arthroplastyTotal knee arthroplasty |
| spellingShingle | Olivia K. Blaber Patrick Ioffreda Jenna Adalbert Irfan A. Khan Jess H. Lonner Opioid-free postoperative pain management in total knee and hip arthroplasty: A scoping review Journal of Orthopaedic Reports Opioid-free Postoperative pain Multimodal pain regimen Total joint arthroplasty Total hip arthroplasty Total knee arthroplasty |
| title | Opioid-free postoperative pain management in total knee and hip arthroplasty: A scoping review |
| title_full | Opioid-free postoperative pain management in total knee and hip arthroplasty: A scoping review |
| title_fullStr | Opioid-free postoperative pain management in total knee and hip arthroplasty: A scoping review |
| title_full_unstemmed | Opioid-free postoperative pain management in total knee and hip arthroplasty: A scoping review |
| title_short | Opioid-free postoperative pain management in total knee and hip arthroplasty: A scoping review |
| title_sort | opioid free postoperative pain management in total knee and hip arthroplasty a scoping review |
| topic | Opioid-free Postoperative pain Multimodal pain regimen Total joint arthroplasty Total hip arthroplasty Total knee arthroplasty |
| url | http://www.sciencedirect.com/science/article/pii/S2773157X24001498 |
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