Pain protocol eliminates need for opioids following knee replacement in most patients

A study led by Vinod Dasa, MD reports that a novel surgical pain management strategy following total knee arthroplasty (TKA), or total knee replacement, provided pain relief without opioids.

The researchers also found that changing prescriptions for opioids at discharge from automatic to upon request dramatically decreased opioid use.

"About 70% of opioid-naïve patients needed only Tylenol and anti-inflammatory medications to manage their pain," notes Dr. Dasa. "Opioid use in health care is improving but remains difficult to manage. Surgical pain was long thought to be unavoidable, requiring a large amount of pain medications. Creating innovative strategies to enhance surgical recovery by reducing pain and eliminating opioids can help solve some of our biggest challenges."

The 144 patients in the retrospective study received the same multimodal analgesia protocol except for postoperative opioid prescribing. The novel multimodal analgesia regimen included percutaneous cryo-neurolysis, a long-acting nerve block, about five days before surgery. Immediately before surgery, patients received a single dose of 150 mg pregabalin, 200 mg celecoxib, and 1000 mg intravenous (IV) acetaminophen.

Upon discharge, all patients were advised to take 325 mg of acetaminophen every four hours for two weeks and 75 mg of diclofenac every 12 hours for 6 weeks.

The authors conclude, "More than half of all TKA patients and 72% of opioid-naïve patients who were treated with a multimodal pain protocol designed to minimize opioid use for up to 3 months, and received opioids only upon request after surgery, recovered from TKA without the use of any opioids and any worsening of self-reported pain or knee-related problems compared with patients who received an opioid prescription automatically upon discharge."

I speak from years of experience here.

Was put on oxycodone/hydrocodone in the beginning it is bad stuff, very addictive, withdrawal symptoms, itching while taking it. I have finally got switched over to morphine sulfate extended release. I can stop taking that whenever and no withdrawal symptoms of any kind but my pain comes right back. I’ve got severe neuropathy and the pains change all the time from cramps, numbness, feeling freezing cold (like they are in a bucket of ice water) to Me and normal to others, lightning bolts like Sciatica but only in the feet, feeling like a pair of Vise Grips clamped down on them, stabbing
feeling, being hit with a hammer in both feet that comes and goes whenever. My hands get the ice water thing, cramps and the Dropsies of even large items, severe loss of dexterity and I’ve had this condition for over 10 years and is getting worse.

Aspirin/Tylenol/Motrin/Alive are all useless for Me and add Diflucan, etc to the list. My long time Doc retired and now I must use a Pain clinic. One of
the first things they did was replace the Morphine pills with some stupid 1” square sheets that go between the cheek and gum that melt away. MORE USLESS CRAP AND a 30 day supply (60 sheets) cost $880.00 !!!

There was one pill that was supposed to be super powerful stuff that was $600.00 a month. I looked up about it and it was created by the nazis back in the 1930’s that is also a waste of time and money. My 30 day supply of Morphine 30mg ER is only $32.00.

And through all of the mess the goobermint is blaming the death of the actual junkies that are overdosing themselves with the crap from the chicoms and mexicans on people that have nothing to do with it.

Then there’s the piss testing for another hassle and the accusations of those of Us being legally in possession of selling or trading Our meds on the street. Maybe some do but My Rx is for Me and nobody else it’s a pain in the ass to just not be in pain all the time.

So all the damned doctors, political scumbags and media can KISS MY ASS !!!

The solution to the junkie problem IMO is simple. Get busted 1 time and get mandatory rehab. The second time, a bullet in the head ! Problem solved.

< /rant > for now.

Time for dinner.

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