A Comparison of Patient Outcomes Using Multimodal Analgesia Versus Opioid-Based Pain Management in Total Joint Arthroplasty.

Abstract

Multimodal analgesia (MMA) pain management following total joint arthroplasty (TJA) is gaining momentum as a best practice. Many forces in healthcare are coming together challenging orthopaedic teams to reevaluate postoperative pain management following surgery including the opioid crisis and pressures to improve patient experience with early discharges following surgery. Measuring the effect of adjustments to pain management is an important step. This retrospective, observational study evaluated the effect of a multimodal postoperative analgesia regimen on patient outcomes and opioid use at a Midwest academic medical center. Two cohorts of patients were compared. Those who underwent TJA from November 2016 to April 2017 and received pain management by the traditional supplemental "as-needed" opioid-based pain management order set and patients who underwent TJA from September 2017 to February 2018 whose pain was managed by the scheduled multimodal pain management order set. For patients in the MMA group, there was a significant difference in pain control on postoperative day 1 (p = .04) in addition to decreased hospital length of stay (LOS) (p = .0001). Opioid consumption in the MMA group was lower compared to the traditional supplemental "as-needed" opioid-based pain management cohort. Implementation of the MMA regimen at this institution led to improved postoperative pain control, reduced LOS, less consumption of opioids, antiemetic, and antipruritic medications in TJA patient population.