Reduction seen in antiemetic use, nonsignificant reduction in length of stay, increase in proportion discharged to home
By Elana Gotkine HealthDay Reporter
MONDAY, March 11, 2024 (HealthDay News) — Elimination of extended-release (ER) opioids in the multimodal medication regimen of total knee replacement (TKR) patients can improve outcomes, including reducing antiemetic use, according to a study published online Feb. 8 in Pain Management Nursing.
Anoush Kalachian, D.N.P., from Englewood Health in New Jersey, and colleagues conducted a retrospective chart review to examine an institution’s current postoperative pain protocol and assess whether elimination of ER opioids in the multimodal medication regimen could improve TKR patient outcomes.
Sixty patients (mean age, 70 years) were reviewed preprotocol and postprotocol (36 and 34 patients, respectively). The researchers identified reductions in antiemetic use and length of stay, and an increase in discharges to home versus rehabilitation facility (67 percent in the postprotocol group versus 53 percent in the preprotocol group). Upon discharge, all patients received 30 tablets of only one opioid prescription, with no refill; these included oxycodone-immediate release, hydromorphone, and tramadol (82, 5, and 12 percent, respectively).
“Studies have shown that extended-release or long-acting opioids increase the risk of opioid dependence and possible addiction because of the greater concentration of the drug and the longer time that they remain in the body,” coauthor Judith Barberio, Ph.D., from Rutgers Biomedical and Health Science in Newark, New Jersey, said in a statement. “If you can move from long-acting to immediate-release opioids without increased pain or other adverse effects, that’s a win. This quality improvement project suggests it’s possible to do that when recovering from a total knee replacement.”
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