Poster Presentation
Friday, 21 July 2006
10:00 AM - 10:30 AM
Friday, 21 July 2006
3:00 PM - 3:30 PM
This presentation is part of : Poster Presentations III
Long-Acting Opioids for Treatment of Post-Operative Pain After Total Hip and Total Knee Replacement Surgery
Tabatha L. Bowers, RN, BScN, MN, GNC, Specialized Geriatrics and General Internal Medicine, The Scarborough Hospital, Scarborough, ON, Canada, Shirley L. Musclow, RN, BScN, MN, ACNP, Acute Pain Service, The Scarborough Hospital, Scarborough, ON, Canada, Hannah Vo, BScPh, Inpatient Pharmacy, The Scarborough Hospital, Scarborough, ON, Canada, Thong Nguyen, BSc, Physiotherapy, The Scarborough Hospital, Scarborough, ON, Canada, and Mark Glube, MD, FRCP, Anaesthesiology, The Scarborough Hospital, Scarborough, ON, Canada.
Learning Objective #1: The learner will be able to determine whether the use of a long-acting opioid for post-surgical pain is effective in optimizing pain management.
Learning Objective #2: The learner will be able to adapt the presented information to their own work environments regarding the use of long-acting opioids in post-surgical pain
Hypothesis: Uncontrolled pain after total joint replacement surgery interferes with joint rehabilitation. The coordination of PRN administered analgesia and physiotherapy treatment is not always well managed. We hypothesized that long-acting opioids (LAO) would benefit this patient population.

Methods: A double-blinded, randomized controlled trial of 200 patients scheduled for total joint replacement surgery was initiated in March 2004. Patients were followed during hospitalization for a maximum of 7 days. All patients received routine post-operative analgesia (PCA until day two after surgery, an NSAID, and Oxycodone 5mg + acetaminophen 325 mg PRN after discontinuation of PCA). The treatment group received an additional 30mg of long-acting morphine q12h x 3 days starting on the first day after surgery while the control group received placebo capsules. Pain scores, adverse effects, sleep ratings, acute confusion, improvement in function, use of analgesia, and patient satisfaction data was collected.

Results: In an interim analysis of 101 patients, a trend of lower pain scores was reported for the treatment group. No statistical significance was found between groups for satisfaction with pain control. Although the treatment group showed a trend towards higher side effects, there was no statistical difference in adverse effects between the two groups. There was no statistical difference between groups for acute confusion. Patients in the treatment group reported less interference with sleep due to pain compared to the control group (P=0.0373). The treatment group was directionally slower to ambulate after surgery (P=0.0878). However, the treatment group showed evidence of shorter length of stay in acute care by 1.4 days.

Conclusions: Long-acting opioids are a safe and effective treatment for post-operative pain of total joint replacement surgery. Patients may have improved sleep, pain, and potentially a shorter length of stay without risk of increased confusion. However, consideration may need to be given to potential side effects.

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