Opioid Use Following Knee Replacement Surgery - Managing Pain Safely

Introduction

Opioid abuse is a serious public health issue, with 11.4 million Americans over the 12 years reporting using opioid medications inappropriately. Misuse is typically understood to be the inappropriate use of a substance for therapeutic purposes. The effects of some types of opiate abuse can be very serious. The disease prevention and control offices for prescribers created overdose risk categories for prescribers. According to these highlights, even modest doses of use (20 to 50 morphine milligram equivalents per day) increase the risk of overdose, and when use is at or above 50 MMEs/day (vs. 20 MMEs), the risk of overdose doubles. The opioid is prescribed only for pain management in knee replacement surgery (a type of total joint arthroplasty). Total joint arthroplasty (TJA) is a surgical procedure in which a damaged or arthritic joint is replaced with an artificial joint, also called a prosthesis. Opioids are used for treating pain in knee replacement surgery for 14 days. This article will discuss guidelines for opioid use after knee replacement surgery.

What Is Knee Replacement Surgery?

Knee replacement surgery is a type of total joint arthroplasty (TJA). TJA is a general term used to describe a surgical procedure that replaces a damaged joint with an artificial joint. Knee replacement surgery specifically replaces the damaged or arthritic knee joint with an artificial knee joint. Other types of TJA include hip replacement surgery, shoulder replacement surgery, and ankle replacement surgery, among others. So, knee replacement surgery is a specific type of TJA that only focuses on replacing the knee joint. The goal of TJA is to relieve pain, restore joint function, and improve quality of life. It is a highly effective treatment for severe joint pain and disability caused by arthritis, injury, or other conditions that affect the joints.

What Are the Uses of Opioids?

Opioids are a class of drugs that are primarily used for pain relief. They work by binding to specific receptors in the brain and spinal cord to decrease the sensation of pain. The opioids are used for a minimum of 14 days after knee replacement surgery for treating pain.

Here are some of the uses of opioids:

• Pain Relief: Opioids are commonly prescribed for acute and chronic pain, such as pain after surgery, cancer-related pain, and pain due to injuries.

• Cough Suppression: Some opioids, such as Codeine and Hydrocodone, are also used as cough suppressants.

• Anesthesia: Opioids can be used in combination with other drugs to induce anesthesia for surgery.

• Addiction Treatment: Certain opioids, such as methadone and buprenorphine, can also be used to treat opioid addiction and help with opioid withdrawal symptoms.

What Are the Side-Effects of Opioids?

Various side effects can be brought on by opioids, some of which can be serious. Here are some of the common side effects of opioids:

• Constipation: Opioids can slow down bowel movements and cause constipation.

• Nausea and Vomiting: Opioids can cause nausea and vomiting, particularly when first starting the medication.

• Drowsiness: Opioids can cause drowsiness, which can impair a person's ability to drive or operate machinery.

• Dizziness: Opioids can cause dizziness and lightheadedness.

• Respiratory Depression: High doses of opioids can suppress breathing, which can be life-threatening.

• Itching: Opioids can cause itching, particularly on the skin.

• Hormonal Changes: Opioids can affect hormone levels, which can cause a range of symptoms, including low testosterone levels in men.

• Addiction and Withdrawal: Opioids can be highly addictive, and prolonged use can lead to physical dependence and withdrawal symptoms when stopping the medication.

How to Counsel Patients for Avoiding Opioid Use?

The opioid crisis has alarmed prescribers to the fact that close monitoring of opioid use, long-term use, and misuse is important to thwarting later dependence. Prescribers can use alternative methods for pain management other than opioids. Opioids are strictly prescribed in major surgery.

Opioids dependence can be avoided by counseling the patients before surgery such as:

• The healthcare providers should discuss with patients the pain they may expect to have after the procedure.

• Patients should be counseled that pain immediately after surgery is a part of the surgery and it is normal.

• Patients should be made aware that in the first one to two days after surgery, pain can be worse, but improves over time.

• Patients should be taught that pain is considered a part of healing.

• Depending on the patients, an alternative to opioids can be used for managing pain, such as non-steroidal anti-inflammatory drugs (NSAIDs), Acetaminophen, Gabapentin, and topicals.

• After prescribing opioids patients need to know their side effects such as high risk of physical dependence, addiction, and overdose.

• Opioids should be used only when pain is not treated by others and should be discontinued when the pain is controlled by non-opioid pain relievers or other methods.

• To reduce the amount of opioids consumed, they should be administered in addition to, not as a substitute for, non-opioid pain relievers.

• To prevent misuse or diversion, unused opioids should be disposed of properly.

What to Expect With Opioid Use?

The following is some guidance for patients who are prescribed opioids after knee surgery:

• Do not increase opioids above prescribed levels.

• Before surgery, establish a postoperative strategy with the patient's pain management or pain medicine physician.

• Consider tapering as soon as the acute pain is anticipated to go away if surgery was done to treat chronic pain (such as an arthroplasty for end-stage osteoarthritis).

• Consider a slow taper and talk with the patient's prescribing doctor if surgery does not address the cause of the patient's chronic pain.

What Are Alternatives for Opioids?

Opioid addiction can be avoided by using alternatives for pain management:

• Non-opioid Pharmacologic Treatments

  • Non-steroidal Anti-inflammatory Drugs.

  • Acetaminophen.

  • Antidepressants.

  • Topical medications.

  • Neuromodulating medications.

• Non-Pharmacologic Treatments

  • Physical Therapy - Physiotherapy is one of the best methods to restore mobility and reduce pain over time.

  • Cognitive Behavioral Therapy - Cognitive behavioral therapy (CBT) is a short-term form of behavioral treatment. It helps people in problem-solving.

  • Acupuncture - Acupuncture is the traditional method to insert needles into specific points of the body to reduce pain.

  • TENS units - TENS units operate by delivering tiny electrical impulses through electrodes that are attached to a person's skin with adhesive pads. An overflow of electrical impulses impairs the nervous system's capacity to feel pain and thus reduce pain.

  • Ice - Applying ice over the joints helps to reduce the swelling and, the cold from the ice has an analgesic effect which reduces pain.

  • Elevation and Compression - Elevation and compression methods help in improving blood circulation and reducing pain.

Conclusion

It is clear from the results that all healthcare providers should consider prescribing opioid medication to ensure minimal risk of overprescribing or prescribing for a long duration. The close monitoring of the number of opioid prescriptions that patients receive, and several other practices may decrease the patient’s risk. The patients should be counseled about nonopioid pain management through rest, icing, compression, elevation, and physical therapy exercises that follow surgery, leading to slower recovery and longer recovery periods.