Less antiemetic use, a non-significant drop in length of stay, and a rise in the number of patients sent home.

THE 11TH OF MARCH 2024 (MONDAY) — A study released online on February 8 in Pain Management Nursing says that taking extended-release (ER) opioids out of the multimodal medication regimen of total knee replacement (TKR) patients can improve outcomes, such as lowering the need for antiemetic drugs.

Anoush Kalachian, D.N.P., from Englewood Health in New Jersey, and his coworkers looked back at old patient records to find out what an institution’s current postoperative pain protocol was and to see if taking ER opioids out of the multimodal medication regimen could make things better for TKR patients.

Sixty patients, with a mean age of 70 years, were looked at before and after the procedure (36 patients before and 34 patients after). Antiemetic use and length of stay went down, and more people were sent home from the rehabilitation center (67 percent in the postprotocol group vs. 53 percent in the preprotocol group), according to the researchers.

All patients who were sent home got 30 pills of only one opioid prescription, and they did not get a refill. The opioids were oxycodone-immediate release, hydromorphone, and tramadol, which made up 82%, 5%, and 12% of the total.

This is because extended-release or long-acting opioids stay in the body longer and have a higher concentration of the drug. This makes the risk of opioid dependence and possible addiction higher, according to a statement from coauthor Judith Barberio, Ph.D., from Rutgers Biomedical and Health Science in Newark, New Jersey. “It’s a win if you can switch from long-acting opioids to immediate-release opioids without making the pain worse or causing other problems.” This project to improve quality shows that it is possible to do that while recovering from having a total knee replacement.