Khellah Mahmoud, Huff Thomas, Schabel Kathryn, Foerster Jessica, Esposito Leah, Rushkin Megan, Kagan Ryland
Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
Arthroplast Today. 2025 May 26;33:101716. doi: 10.1016/j.artd.2025.101716. eCollection 2025 Jun.
A collaborative effort with pharmacy, nursing and surgeons developed a multimodal pain management protocol for total hip and knee arthroplasty. This investigation aims to evaluate the effectiveness in reducing opiate consumption.
Retrospective cohort study comparing 455 total hip and knee arthroplasty patients. We compared the first 206 multimodal pain management protocol and 249 standard-of-care pathway patients from January 2017 to March 2020. Primary outcome was postoperative morphine milligram equivalents (MMEs) per 24 hours. Secondary outcomes included total MME at discharge and total MME in the first 6 weeks following discharge.
Postoperative MME per 24 hours was lower in the multimodal pain management protocol group 57.0 (30.5, 94.3) median (interquartile range), compared with the standard of care group 84.7 (50.4, 139.6), < .001. MME prescribed at discharge was reduced in the multimodal pain management group 300 (224, 450) compared to the standard of care group 525 (400, 750), < .001. MME prescribed 6 weeks following discharge was reduced in the multimodal pain management group 150 (0, 590.6) compared to the standard of care group 400 (0, 1050), = .01. Additionally, the length of stay was reduced in the multimodal group, = .01, with similar postoperative pain scores across groups.
Our collaborative multimodal pain management pathway reduced opiate consumption for patients undergoing total hip and knee arthroplasty with a reduction in LOS, no difference in pain scores and was effective for patients with various levels of opiate requirements.
Level III Therapeutic Study: retrospective comparative study.
药学、护理和外科医生共同努力，为全髋关节和膝关节置换术制定了多模式疼痛管理方案。本研究旨在评估该方案在减少阿片类药物使用方面的有效性。
回顾性队列研究，比较455例全髋关节和膝关节置换术患者。我们比较了2017年1月至2020年3月期间的前206例多模式疼痛管理方案患者和249例标准护理路径患者。主要结局是术后每24小时的吗啡毫克当量（MME）。次要结局包括出院时的总MME和出院后前6周的总MME。
多模式疼痛管理方案组术后每24小时的MME较低，中位数（四分位间距）为57.0（30.5，94.3），而标准护理组为84.7（50.4，139.6），P<0.001。多模式疼痛管理组出院时开具的MME为300（224，450），低于标准护理组的525（400，750），P<0.001。多模式疼痛管理组出院后6周开具的MME为150（0，590.6），低于标准护理组的400（0，1050），P=0.01。此外，多模式组的住院时间缩短，P=0.01，各组术后疼痛评分相似。
我们的多模式疼痛管理方案减少了全髋关节和膝关节置换术患者的阿片类药物使用，缩短了住院时间，疼痛评分无差异，对不同阿片类药物需求水平的患者均有效。
III级治疗研究：回顾性比较研究。
