Posted on 02/28/2023 10:12:00 AM PST by ConservativeMind
A study led by Vinod Dasa, MD reports that a novel surgical pain management strategy following total knee arthroplasty (TKA), or total knee replacement, provided pain relief without opioids.
The researchers also found that changing prescriptions for opioids at discharge from automatic to upon request dramatically decreased opioid use.
"About 70% of opioid-naïve patients needed only Tylenol and anti-inflammatory medications to manage their pain," notes Dr. Dasa. "Opioid use in health care is improving but remains difficult to manage. Surgical pain was long thought to be unavoidable, requiring a large amount of pain medications. Creating innovative strategies to enhance surgical recovery by reducing pain and eliminating opioids can help solve some of our biggest challenges."
The 144 patients in the retrospective study received the same multimodal analgesia protocol except for postoperative opioid prescribing. The novel multimodal analgesia regimen included percutaneous cryo-neurolysis, a long-acting nerve block, about five days before surgery. Immediately before surgery, patients received a single dose of 150 mg pregabalin, 200 mg celecoxib, and 1000 mg intravenous (IV) acetaminophen.
Upon discharge, all patients were advised to take 325 mg of acetaminophen every four hours for two weeks and 75 mg of diclofenac every 12 hours for 6 weeks.
The authors conclude, "More than half of all TKA patients and 72% of opioid-naïve patients who were treated with a multimodal pain protocol designed to minimize opioid use for up to 3 months, and received opioids only upon request after surgery, recovered from TKA without the use of any opioids and any worsening of self-reported pain or knee-related problems compared with patients who received an opioid prescription automatically upon discharge."
(Excerpt) Read more at medicalxpress.com ...
I have a friend who just had this done, but he liked what the opioids provided, minus the withdrawal he got when his doctor’s script wrongly said it could not be reupped after one week.
He had severe anxiety and loss of sleep, after his Viocodin ran out at one week. He had to ride it out.
The doctor later apologized for that and said he didn’t intend no renewal.
That sucked.
I used opioids after my hip replacement. They helped more than other pain meds.
Yep, I got some opioids after my last knee operation. Tried them once when the leg was hurting, but really didn’t like the feeling so I tossed the bottle.
Was riding my bike to work 4 days after the op. It hurt but it’s best to keep the joint moving.
The glorious thing about humans is that while we are all the same, we are all different.
They told me to double up the opioids for my anal fissure repair as the hospital lowered the dose the surgeon intended. Then, because they were used up too fast, I got to suffer for days as his office would not refill while he was away on a mission trip. As with gun control measures, only the innocent/law abiding suffer.
An 82 year old friend had robotic knee replacement surgery last month and has had no pain....no need for pain meds.
Rehab personnel say he’s 3 weeks ahead of schedule on his recovery.
That’s great. But, Everyone is different.
Remember when they didn’t have knee replacements?
My dad had bad knees, real bad knees and he sucked it up and took the pain like a man. He didn’t even do aspirin. He always said that pain was just a reminder that you’re still alive.
The biggest drag on healthcare systems throughout ‘first world’ countries is knee, hip and other joint replacements. They should ban them.
You know what people don’t get in third world countries? Knee replacements.
I had cervical stenosis and was on low dose oxy for 8 weeks. Fortunately no surgery was needed. The initial pain was so bad I needed it but after the second shot I started weaning myself off of it. No buzz, no high, just blessed pain relief.
They gave me oxy when I had my shoulder surgery. Took 1 the next day and it weirded me out that I stopped them. Otc plus ice machine plus doing the exercises religiously.
Just pointing out its possible
If they tell me to take 2 every 4 hrs, I take one every 6 or more hrs.
Everyone is different. Opioids helped me a great deal with both knee replacements. I don’t think I could have gone through it without them. They allowed me to get up and be mobile. I don’t think Tylenol would have done anything for that level of pain. I took them for four weeks, and withdrawal involved some weariness, irritability, and headaches for three days at most, but that was it. I am very glad my doctor did not agree with this study.
BTT
Absolutely. But, treatment should not be the same for everyone.
I've had a knee replacement myself, and frankly I don't believe you. Even with the Oxycodone and a pump feeding something (fentanyl?) into the leg I was in agony for almost two weeks. I'd rather live on crutches like I was before the surgery than suffer recovery without opioids.
I know several years ago the dentist told me after a procedure for which he had previously prescribed opiods to switch asap to a combination of Tylenol and Motrin, so I skipped the script and tried them and the combination worked well for me.
Everyone is different, and for those for whom this works, it is great. I think doctors should be very alert to how well it works for each patient.
I also want to say that when the dentist did prescribe opioid, he always said to take at the first sign of pain so they would work better. I really think that made people pay too much attention to their pain and become a bit paranoid about it and I think this led to a lot more addiction. (I never paid attention to that advice because I was more paranoid about addiction than about pain.)
> I’ve had a knee replacement myself, and frankly I don’t believe you.
OK, I’m lying. It wasn’t a knee replacement it was a meniscal and some other stuff cleanup. 3rd operation.
I don’t believe you had a knee replacement - it was most probably your frontal lobe.
Yes, it’s harder to get addicted to opiods when you are using them to treat actual pain. But it’s very easy to keep taking them when you don’t need them anymore, and that’s where the trouble starts.
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