Cryoneurolysis prior to TKA may reduce opioid prescriptions, improve function
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NEWPORT BEACH, Calif. — Cryoneurolysis prior to total knee arthroplasty may improve function and reduce the number of opioids prescribed and used, according to a presenter at the Interdisciplinary Conference on Orthopedic Value-Based Care.
In his presentation, Vinod Dasa, MD, noted that a retrospective chart review that he and his colleagues performed showed that patients who received cryoneurolysis prior to TKA for treatment of knee osteoarthritis had no differences in terms of KOOS and Patient-Reported Outcomes Measurement Information System compared with patients who did not receive cryoneurolysis. He also noted patients who had cryoneurolysis received 45% fewer narcotics.
“At the time, this is back in 2013/2014, we were doing outpatient total joints back then. What we found was in the cryoneurolysis group, we had a small difference in length of stay, as well,” Dasa said in his presentation. “We had a higher percentage going home on the same day.”
Another study published by Dasa and colleagues showed significantly more patients who received cryoneurolysis prior to TKA had 90° of flexion earlier, as well as 120° of flexion, compared with patients who received standard of care.
Regarding opioid consumption, Dasa noted a study published by William M. Mihalko, MD, PhD, and colleagues showed patients who received cryoneurolysis prior to TKA consumed 34% fewer opioids. At 6 weeks postoperatively, 45% of patients in the cryoneurolysis group were off opioids vs. 14% in the non-cryoneurolysis group.
“To me, that’s the most compelling part of this and that’s the thing most of us want to get to is how quickly can you get to zero [opioids]? Because if you’re still taking one Percocet at 10 weeks, that’s still a problem,” Dasa said.
Shortly after the pause in elective surgery due to the COVID-19 pandemic, Dasa said he stopped prescribing opioids among patients undergoing cryoneurolysis prior to TKA. Among 40 patients, he noted 32 were opioid naïve prior to surgery. Of the opioid-naïve patients, 85% were opioid-free postoperatively and managed pain adequately with acetaminophen and NSAIDs, according to Dasa.
“The next study is comparing the group that did get opiates to the opiate-free group to look at their pain scores and function scores, and I’ll tell you it didn’t change,” Dasa said. “The opiate-free patients had the exact same pain and function scores as the non-opiate patients. So, we weren’t torturing them, tell them we’re withholding, being a mean doctor and you’re miserable. Their pain scores were exactly the same.”
References:
- Bronstone AB, et al. Journal of Orthopaedic Experience & Innovation. Multimodal opioid-sparing analgesia for total knee arthroplasty: Results from a retrospective case series of 40 patients. March 2022.
- Dasa V, et al. Knee. 2016;doi:10.1016/j.knee.2016.01.011.
- Dasa V. Pain management in total knee: Chilling the pain. Presented at: Interdisciplinary Conference on Orthopedic Value-Based Care; April 29-30, 2022; Newport Beach, Calif.
- Mihalko WM, et al. J Arthroplasty. 2021;doi:10.1016/j.arth.2020.11.013.
- Plessl D, et al. J Am Acad Orthop Surg. 2020;doi:10.5435/JAAOS-D-19-00597.
- Radnovich R, et al. Osteoarthritis Cartilage. 2017;doi:10.1016/j.joca.2017.03.006.
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