Eliminating Extended-Release Opioids from a Postoperative Pain Protocol for Total Knee Replacement Patients

Anoush Kalachian; Judith Barberio; Jill Cox

doi:10.1016/j.pmn.2023.12.016

Eliminating Extended-Release Opioids from a Postoperative Pain Protocol for Total Knee Replacement Patients

Pain Manag Nurs. 2024 Feb 8:S1524-9042(23)00253-9. doi: 10.1016/j.pmn.2023.12.016. Online ahead of print.

Authors

Anoush Kalachian¹, Judith Barberio², Jill Cox²

Affiliations

¹ Englewood Health, Englewood, New Jersey. Electronic address: Anoush.Costanian@EHMCHealth.org.
² Rutgers Biomedical and Health Sciences, School of Nursing, Division of Nursing Science, Newark, New Jersey.

PMID: 38336528
DOI: 10.1016/j.pmn.2023.12.016

Abstract

Purpose: To determine whether the elimination of extended release (ER) opioids in the multimodal medication regimen of total knee replacement (TKR) patients resulted in improved patient outcomes.

Design: Retrospective cohort quality improvement.

Methods: This project utilizes a retrospective chart review to evaluate an institution's current postoperative pain protocol. The outcomes of interest include mean hospital length of stay, discharge disposition, mean pain score, antiemetic use, mean opioid dose used, and number of opioid discharge prescriptions.

Results, conclusions, and clinical implications: Sixty patients were reviewed with a mean age at 70 years for both the pre-protocol (n = 36) and post-protocol groups (n = 34). There was a reduction in antiemetic use, t(59) = 2.2, p = .03 and length of stay, t(58) = 1.0, p = .33, and more discharges to home than rehab, x² = 60, p < .001. All patients received 30 tablets of only one opioid prescription upon discharge with no refill, either oxycodone-IR (82%, n = 49), hydromorphone (5%, n = 3), or tramadol (12%, n = 7). The project, aimed to reduce opioid overprescription and overconsumption, has the potential to improve prescribing practices, promoting patient safety and healthcare quality by supporting the current guidelines that recommend against using ER opioids for the study population.