Patients who are dependent on narcotics for pain management before knee replacement surgery have much more difficulty recovering, a study recently published in the Journal of Bone and Joint Surgery has found.
Compared to patients who are not opioid-dependent, these patients tend to have longer hospital stays, more post-surgical pain, a higher rate of complications, and a greater need for additional procedures, according to the study.
"We expected to find that the opioid-dependent patients have worse outcomes," says orthopedic surgeon Michael A. Mont, MD, the principal investigator and director of the Center for Joint Preservation and Reconstruction at Sinai Hospital's Rubin Institute for Advanced Orthopaedics in Baltimore. "But the differences between the 2 groups of patients were even greater than we thought they would be. The chronic narcotics users did significantly worse in every category."
The study found that chronic opioid users:
had to remain in the hospital longer after surgery;
were more likely to need referrals for pain management;
were more likely to suffer unexplained pain or stiffness; and
had lower function and less motion in the replaced knee.
"This doesn't mean that opioid users shouldn't have the surgery," says Dr. Mont. "But those patients and their physicians should know that their results may not be as optimal."
The researchers suggest several strategies to help improve patient outcomes, including weaning patients off strong opioid medications before surgery; prescribing alternative, non-opioid pain medications; or considering non-pharmaceutical pain management strategies.
Dan O'Connor
