Opioids in Total Joint Arthroplasty
Patient Guideline Summary
Publication Date: March 1, 2020
This patient summary means to discuss key recommendations from the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society about Opioids in Total Joint Arthroplasty. It is limited to adults 18 years of age and older and should not be used as a reference for children.
- Opioids like morphine and fentanyl are highly effective at relieving acute pain, but they all may depress respiration and increase sedation especially if combined with other opiods. Note: Overdose can be lethal.
- We will use the abbreviation TJA throughout this summary to refer to total joint arthroplasty.
- This patient summary focuses on the use of opioids for pain due to joint surgery.
- Chronic use of opioids prior to surgery leads to inferior patient-reported outcomes, increased opioid consumption after surgery, an increased risk for chronic opioid use, and an increased risk of complications after TJA.
- Reduction of chronic opioid use prior to TJA may lead to improved patient-reported outcomes after TJA.
- An opioid administered immediately prior to surgery reduces postoperative pain and opioid consumption after surgery.
- An opioid administered during surgery reduces opioid consumption but does not affect postoperative pain.
- Scheduled opioid administration without multimodal analgesia within 72 hours after surgery reduces the need for additional opioid pain medications for breakthrough pain and may reduce postoperative pain, but providing scheduled opioids is discouraged since it may increase the risk of complications.
- Prescribing lower quantities of opioid pills at discharge may lead to equivalent patient-reported outcomes, pain relief, reduced opioid consumption, and fewer unused opioid pills.
- Tramadol administered within 24 hours after surgery may reduce postoperative pain and opioid consumption after surgery but may be associated with adverse events such as dizziness and dry mouth.
- Any use of opioids risks complications such as respiratory depression and sedation. The greater the dose of opioids, the greater the risk.
- TJA: Total Joint Arthroplasty
Hannon CP, Fillingham YA, Nam D, Courtney PM, Curtin BM, Vigdorchik JM, Buvanendran A, Hamilton WG, Della Valle CJ; AAHKS Anesthesia & Analgesia Clinical Practice Guideline Workgroup. Opioids in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplasty. 2020 Oct;35(10):2709-2714. doi: 10.1016/j.arth.2020.05.034. Epub 2020 May 26. PMID: 32571594.
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.