Painkiller Dependence Before Knee Surgery May Slow Recovery
FRIDAY Nov. 18, 2011 -- Recovery after knee replacement surgery can be much more difficult if patients are dependent on powerful opioid painkillers before the procedure, a new study shows.
Opioids are narcotics such as morphine, codeine and oxycodone.
U.S. researchers compared results of 49 knee replacements in opioid-dependent patients against recovery rates for a group of patients not dependent on narcotics. They found that patients who were opioid-dependent before surgery tended to have longer hospital stays, more unexplained pain or stiffness, a higher rate of complications and were more likely to require additional surgery, compared to patients who were not opioid-dependent.
The study was published Nov. 2 in the Journal of Bone and Joint Surgery.
"We expected to find that the opioid-dependent patients have worse outcomes. But the differences between the two groups of patients were even greater than we thought they would be. The chronic narcotics users did significantly worse in every category," principal investigator Dr. Michael A. Mont, director of the Center for Joint Preservation and Reconstruction at the Rubin Institute for Advanced Orthopedics at Sinai Hospital of Baltimore, said in a journal news release.
"This doesn't mean that opioid users shouldn't have the surgery," he added. "But those patients and their physicians should know that their results may not be as optimal. It might be possible that we can work with these patients to improve their surgical outcomes."
Mont and his colleagues suggested several ways to improve recovery for opioid-dependent knee surgery patients. These include: weaning them off strong opioid medications before surgery; prescribing alternate, non-opioid pain medications; and using drug-free pain management methods.
"Previous studies have found that patients who use opioids are more dissatisfied after surgery," Mont said. "But these are more powerful findings since patients require additional surgeries. This is a topic our orthopedic community and other care providers need to address together."
The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about joint replacement surgery.
Posted: November 2011
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