Reducing persistent postoperative opioid use after total hip and knee arthroplasty

Abstract

Opioid analgesics remain a cornerstone agent for the management of moderate to severe postoperative pain. However, the clinical utility of opioid analgesics is limited by their side effects, such as gastrointestinal adverse events, sedation, opioid-induced ventilatory impairment, and central nervous system depression. Rates of persistent postoperative opioid use are among the highest following hip and knee arthroplasty compared with other procedures, with up to 40% of patients reporting opioid use at 3 months or longer after arthroplasty. Therefore, strategies to reduce the risk of persistent postoperative opioid use following total hip and knee arthroplasty may represent a significant opportunity to reduce patient harm.The overarching aim of this thesis is to explore and address the drivers of persistent postoperative opioid use following total hip and knee arthroplasty. Overall, this doctoral thesis has generated novel insights into opioid-related risk of harms (such as harms related to modified-release opioid use), as well as potential drivers of and strategies to address persistent postoperative opioid use after total hip and knee arthroplasty, particularly in an Australian context. The insights generated from this doctoral work may guide clinicians, administrators, and policymakers in reducing the risk of persistent postoperative opioid use after arthroplasty.