---
title: 'A Modern Multimodal Pain Protocol Eliminates the Need for Opioids for Most Patients Following Total Knee Arthroplasty: Results from a Retrospective Comparative Cohort Study'
type: 'lecture'
url: 'https://doc.social/lectures/a-modern-multimodal-pain-protocol-eliminates-the-need-for-opioids-for-most-patients-follow'
published: '2023-05-10'
author: 'Leland van Deventer, Tulane University Class of 2020: BA in Poltical Economics'
transcript: 'yes'
---

# A Modern Multimodal Pain Protocol Eliminates the Need for Opioids for Most Patients Following Total Knee Arthroplasty: Results from a Retrospective Comparative Cohort Study

Listen here for a short lecture on a new option of opioid free pain management for a total knee arthroplasty!

## Summary

Our 144 patient retrospective cohort study demonstrates very promising results of a multi-modal, opioid free pain regiment for patients undergoing unilateral, primary total knee arthroplasty (TKA).

Study publication information:

Van Deventer L, Bronstone A, Leonardi C, Bennett M, Yager P, Dasa V. A modern multimodal pain protocol eliminates the need for opioids for most patients following total knee arthroplasty: results from a retrospective comparative cohort study. J Exp Orthop. 2023;10(1):20.

PMID: 36806032

DOI: 10.1186/s40634-023-00585-0.

## Transcript

747 words · 6 min · automatically transcribed (aws-transcribe) and not checked by a person; it may contain errors, particularly in names, drugs and dosages. The recording is the source.

[0:02] Hello, my name is Leland Van Devender, and I'm a current medical student at LSUHSC New Orleans School of Medicine. Today, I would like to give a brief presentation of a recent publication of ours known as a modern Multimodal pain protocol eliminates the need for opioids for most patients following Total knee arthroplasty. Results from a retrospective comparative cohort study.
[0:28] I do not have any personal or financial conflicts of interest to disclose. However, I would encourage you to pause the video at this point to review the disclosures of some of the Other authors of this study.
[0:43] For a brief introduction into our study and the topic in general, I'd like to point out the following.
[0:50] Excessive opioid prescriptions following TKA are well documented to be associated with the increased risk of abuse, misuse, overdose, diversion, and dependence.
[1:02] The aim of our study was to determine whether a novel, comprehensive Multimodal analgesia regimen can allow an Opioid Free recovery with no compromise in Pain and function in unilateral TKA patients.
[1:18] Opioid prescription data, patient demographics, Patient-reported outcomes, PROs were all collected and analyzed in this study.
[1:28] In terms of our procedure and the methodology that we used, we had 144 unilateral Primary TKA patients that had their surgeries conducted between 2019 and 2021 by a single orthopedic surgeon.
[1:44] Patients all received the same Multimodal analgesia regimen.
[1:49] Patients were evenly subdivided into either the upon request group, UR or the automatic group.
[1:58] The automatic group received an opioid script at time of discharge following their Surgery versus the patients in the upon request or UR group were not given an opioid prescription at the time of their discharge but were instead instructed to call the office to obtain an opioid prescription if the Pain was severe enough for that patient.
[2:22] The Multimodal analgesia regimen consisted of percutaneous cryoneurolysis, which was done approximately 5 days prior to the TKA Surgery date.
[2:33] 150 mg pregabalin, 200 mg of Celoxib, 1000 mg of IV acetaminophen, spinal neuroaxial anesthesia, AD ductor canal block, and perioperative 0.25% buppivacaine hydrochloride Injection.
[2:50] Opioid prescription data were obtained through the Louisiana Prescription Monitoring Program PMP database.
[2:57] Opioid prescriptions filled during the 1st 3 months before TKA were used to identify opioid naive patients, those with no opioid prescriptions, within that 3 month time period, versus opioid experienced patients, those that had 1 or more opioid prescriptions prior to the date of the TKA. PROs were evaluated at preoperative visits and at 2 weeks and 3 months.
[3:24] Following the patient's TKA at follow-up visits.
[3:30] Here are some of the key findings from our study.
[3:33] A higher percentage of the upon request group was Opioid Free 3 months following TKA compared with those in the automatic group.
[3:43] 55.6% of all patients and 72% of opioid naive upon request patients did not receive opioids during the first three months following TKA compared with, respectively, 95.8% and 94.6% of patients who received an opioid prescription automatically upon discharge.
[4:07] There were no statistically significant differences between group differences in PROs following TKA.
[4:16] To help better illustrate one of our key findings, Figure 1 shows that of those patients that were opioid naive in the automatic group following Total knee arthroplasty, 95% of those patients had one or more opioid prescriptions filled after their TKA versus in Fi two.
[4:37] Those that were opioid naive in the upon request group following their TKA 72% had no opioid prescriptions filled following their TKA.
[4:51] Our study's findings suggest that the goal of an Opioid Free Total knee arthroplasty is very realistic for most opioid naive patients.
[5:00] The major challenges indicated by our data are the difficulties of reducing opioid use among opioid experienced patients and controlling opioid prescribing from outside providers.
[5:14] Acute Pain management in opioid tolerant and dependent patients is a complex issue because using opioids sparingly may result in both poor Pain management and opioid withdrawal.
[5:27] In conclusion,
[5:29] Our study found that more than half of all TKA patients and 72% of upon request opioid naive patients who were treated with a Multimodal pain protocol designed to minimize opioid use for up to 3 months following TKA recovered from their Surgery without the use of any opioids.
[5:49] Additionally, these same upon request opioid naive patients did not experience any worsening of self-reported Pain or knee-related problems compared with patients who received an opioid prescription automatically upon discharge.
[6:05] Listed both here and below this video is the publication information for our study.
[6:11] Thank you very much for listening to my presentation and have a wonderful remainder of your day.