Perioperative Opioid Counseling Reduces Opioid Use Following Primary Total Joint Arthroplasty

Christopher N. Carender, Christopher A. Anthony, Edward O. Rojas, Nicolas O. Noiseux, Nicholas A. Bedard, Timothy S. Brown

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Preoperative counseling may reduce postoperative opioid requirements; however, there is a paucity of randomized controlled trials (RCTs) demonstrating efficacy. The purpose of this study was to perform an interventional, telehealth-based RCT evaluating the effect of peri-operative counseling on quantity and duration of opioid consumption following primary total joint arthroplasty (TJA). Methods: Participants were randomized into three groups: 1. Control group, no perioperative counseling; 2. Intervention group, preoperative educational video; 3. Intervention group, preoperative educational video and postoperative acceptance and commitment therapy (ACT). Opioid consumption was evaluated daily for 14 days and at 6 weeks postoperatively. Best-case and worse-case intention to treat analyses were performed to account for non-responses. Bonferroni corrections were applied. Results: 183 participants were analyzed (63 in Group 1, 55 in Group 2, and 65 in Group 3). At 2 weeks postoperatively, there was no difference in opioid consumption between Groups 1, 2, and 3 (p>0.05 for all). At 6 weeks postoperatively, Groups 2 and 3 had consumed significantly less opioids than Group 1 (p=0.04, p<0.001) (Table 1). Group 3 participants were less likely to obtain an opioid refill relative to Group 1 participants (p=0.04). Participants in groups 2 and 3 ceased opioid consumption a median of 6 days and 2 days sooner than Group 1, respectively (p<0.001, p=0.03) (Table 2). Conclusion: Perioperative opioid counseling significantly decreases the quantity and duration of opioid consumption at 6 weeks following primary TJA. Level of Evidence: I.

Original languageEnglish (US)
Pages (from-to)169-177
Number of pages9
JournalThe Iowa orthopaedic journal
Volume42
Issue number1
StatePublished - Jun 1 2022

Keywords

  • counseling
  • opioid
  • total hip arthroplasty
  • total knee arthroplasty

ASJC Scopus subject areas

  • Medicine(all)

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