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EP124 Trends in use of non-opioid analgesic modes over time in inpatient and outpatient total joint arthroplasty
  1. Alex Illescas1,
  2. Jashvant Poeran1,
  3. Haoyan Zhong1,
  4. Lisa Reisinger1,2,
  5. Crispiana Cozowicz2,
  6. Jiabin Liu1,3 and
  7. Stavros Memtsoudis1,3,4
  1. 1Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA
  2. 2Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
  3. 3Department of Anesthesiology, Weill Cornell Medicine, New York, USA
  4. 4Department of Health Policy and Research, Weill Cornell Medical College, New York, USA

Abstract

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Background and Aims Postoperative pain management has shifted towards multimodal analgesia in an effort to limit opioid use. Moreover, there has been a recent shift towards outpatient surgery for a variety of surgeries. It is unclear how this has impacted trends in use of multimodal analgesia. Here, we report trends in use of individual non-opioid analgesic modes for total knee and hip arthroplasties (THA/TKA), stratified by inpatient/outpatient settings.

Methods After institutional review board approval (#2012-050), this retrospective study included all primary THA (n=1,248,761 all/n=21,922 outpatient) and TKAs (n=2,157,056 all/n=54,997 outpatient) from 2006-2022 for both inpatient/outpatient surgeries and 2018-2022 for outpatient surgeries (national US Premier Healthcare data). We calculated the annual percent use of eight non-opioid analgesic modes: acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), COX-2-inhibitors, ketamine, gabapentinoids, steroids, peripheral nerve blocks (PNB), and neuraxial anesthesia. Data were stratified by procedure type and inpatient/outpatient setting.

Results Visual representation of trends can be found in figures 1 and 2. From 2006-2022, PNB use increased more rapidly in TKAs (13.8%-29.7%) than in THAs (9.0%-12.3%). Neuraxial anesthesia followed the same trend in TKAs (31.0%-39.0%) compared to THAs (27.0%-29.0%). Among both procedures and settings, the use of NSAID’s, COX-2-inhibitors, and gabapentinoids peaked in 2017-2018 and have since declined.

Abstract EP124 Figure 1
Abstract EP124 Figure 1
Abstract EP124 Figure 2
Abstract EP124 Figure 2

Conclusions Overall, similar trends among most modes of analgesia existed for both TKAs and THAs, excluding PNBs and neuraxial anesthesia use which increased more rapidly in TKAs. Several modes have declined since 2017-2018. Further research is needed to elucidate mechanisms behind these trends.

  • multimodal analgesia
  • total joint arthroplasty
  • total hip arthroplasty
  • total knee arthroplasty.

https://doi.org/10.1136/rapm-2024-ESRA.197

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