Elsevier

The Journal of Arthroplasty

Volume 33, Issue 12, December 2018, Pages 3637-3641
The Journal of Arthroplasty

Primary Arthroplasty
Should Cannabinoids Be Added to Multimodal Pain Regimens After Total Hip and Knee Arthroplasty?

https://doi.org/10.1016/j.arth.2018.07.027Get rights and content

Abstract

Background

This study investigated the effects of dronabinol on pain, nausea, and length of stay following total joint arthroplasty (TJA).

Methods

We retrospectively compared 81 consecutive primary TJA patients who received 5 mg of dronabinol twice daily in addition to a standard multimodal pain regimen with a matched cohort of 162 TJA patients who received only the standard regimen. A single surgeon performed all surgeries. Patient demographics, length of stay, opioid morphine equivalents (MEs) consumed, reports of nausea/vomiting, discharge destination, distance walked in physical therapy, and visual analog scale pain scores were collected for both groups. Student’s t-tests as well as chi-square or Mann-Whitney U-tests were used for statistical comparisons.

Results

There were no significant differences between the 2 groups for age, gender, body mass index, American Society of Anesthesiologists score, anesthesia type, visual analog scale scores, distance walked with physical therapy, discharge disposition, or episodes of nausea/vomiting. The mean length of stay in the dronabinol group was significantly shorter at 2.3 ± 0.9 days versus 3.0 ± 1.2 days in the control group (P = .02). In the context of a shorter stay, the dronabinol group consumed significantly fewer total MEs (252.5 ± 131.5 vs 313.3 ± 185.4 mg, P = .0088). Although the dronabinol group consumed fewer MEs per day and per length of stay on average, neither of these achieved statistical significance. No side effects of dronabinol were reported.

Conclusion

These findings suggest that further investigation into the role of cannabinoid medications for non-opioid pain control in the post-arthroplasty patient may hold merit.

Section snippets

Methods

This is a retrospective study approved by the institutional review board. All eligible patients had undergone unilateral primary TKA or primary THA between January 2015 and December 2017. Patients either received spinal or general anesthesia (if spinal was unobtainable) as per our standard of care clinical protocol. Additionally, 15 (18.5%) TKA patients in the dronabinol group and 19 (11.7%) TKA patients in the control group received an adductor canal block (P = .13). All adductor canal blocks

Results

There was no significant difference between the 2 groups for age, gender, BMI, American Society of Anesthesiologists scores, initial surgery, and anesthesia type. Mean age for the dronabinol group and the control group was 64.9 ± 9.9 years (range 45-88) and 62.5 ± 10.1 years (range 23.5-90), respectively. The dronabinol group was 65.4% female and the control group 63.5% female (P = .635). Mean BMI was 30.1 and 29.2 kg/m2 for the dronabinol and control groups, respectively (P = .281) (Table 2).

Discussion

The results of this study are encouraging. Patients undergoing THA and TKA who received dronabinol 5 mg twice per day consumed fewer total inpatient opioid medications in the context of shorter lengths of hospital stay, while performing equivalently in terms of other subjective and objective outcome measures in the acute post-operative period. A shorter LOS reflects an earlier satisfaction of discharge requirements, including pain control and function.

It is possible that the total MEs consumed

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2018.07.027.

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