Novel multimodal protocol may reduce narcotic needs and length of stay after TKA
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A 4-month, multimodal protocol of patient-specific preoperative education and unsupervised postoperative rehabilitation “dramatically reduced” patients’ narcotic use, therapy needs and length of stay following total knee arthroplasty.
Maryann Stevenson, RPh, and Andrew Wickline, MD, aimed at improving perioperative pain control and reducing opioid consumption after TKA in their non-selected, prospective, consecutive, 1-year study.
Stevenson and Wickline enrolled 386 patients undergoing unilateral TKA in a 4-month protocol. The patients received “robust” preoperative education, an optimization plan for at-home physical therapy (PT) and a continuous adductor canal block with ropivacaine, the researchers wrote in the study.
“Opioid consumption, numeric rating scale (NRS) pain scores, knee injury and osteoarthritis outcome score for joint replacement (KOOS Jr) and range of motion (ROM) were recorded at baseline and postoperative days 1, 2 and 3 and 3 weeks, 6 weeks and 12 weeks,” the researchers wrote.
“Through 12 weeks, 86.3% of patients undergoing TKA required 10 pills or less and 18.9% required no opioid pills,” they wrote. “Additionally, 85.4% of patients required no formal PT through 12 weeks.” In addition, they wrote, “63.2% of patients were discharged the day of surgery, and 91.2% were discharged by the first postoperative day.”
Of 80.6% of patients who completed the KOOS Jr evaluations, mean KOOS Jr score increased from 53.1 at baseline to 90 at 12 weeks. Mean flexion angle improved among the cohort, and the 90-day readmission rate was 1.2%, the researchers noted.
Stevenson and Wickline concluded that this multimodal protocol could be successful in reducing narcotic and formal PT needs, as well as length of stay following TKA. Further modifications are needed to progress toward a completely opioid-free TKA recovery, they added.
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