LAUSR

BACKGROUND Surgeons have traditionally relied on opiates after hip replacement despite a growing abuse epidemic. This study assessed the efficacy of multimodal analgesia and impact of conservative opiate prescribing after discharge from hip surgery. STUDY DESIGN In this cluster-randomized trial, 235 patients undergoing hip replacement (five surgeons) received one of three discharge pain regimens: scheduled-dose multimodal analgesia with a minimal opiate supply (Group-A), scheduled-dose multimodal analgesia with a traditional opiate supply(Group-B), or a traditional PRN opiate regimen alone(Group-C). Each of the surgeons comprised a distinct cluster, and alternated in a randomized sequence between interventions. The multimodal regimen comprised fixed-schedule doses of acetaminophen, meloxicam, and gabapentin. Primary outcomes were daily VAS pain and opiate utilization for 30-days. Secondary outcomes included satisfaction, sleep-quality, opiate-related symptoms, hip function, and adverse events. The primary intent-to-treat analysis was performed using linear mixed models. RESULTS Daily pain was significantly lower in Group A (Coeff -0.81,p=0.003) and Group B (Coeff -0.61,p=0.021) relative to Group C. While daily opiate utilization in Group A (Coeff -0.77,p<0.001) and Group B (Coeff -0.30,p=0.04) was lower than Group C, opiate use for Group A was also lower than Group B (Coeff -0.46,p=0.002). Duration of opiate use was significantly shorter for Group A(1.14 weeks) and Group B(1.39 weeks) compared with Group C(2.57 weeks). There were fewer opiate-related symptoms, most commonly fatigue, in Group A compared to C, but Groups B and C were not significantly different. Both multimodal regimens improved satisfaction and sleep, and there were no differences in hip function or adverse events. CONCLUSION Multimodal analgesia with minimal opiates improved pain control while significantly decreasing opiate utilization and opiate-related adverse effects. It's time to rethink our reliance on opiates after elective surgery.