Opioid Education in Total Knee Arthroplasty

NCT ID: NCT05593341

Last Updated: 2024-12-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

42 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-09-27

Study Completion Date

2023-09-11

Brief Summary

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The goal of this experimental study is to compare different education intervention on opioid education for patients undergoing total knee arthroplasty. The specific research questions to address are:

1. Does perioperative education pathway reduce opioid refill requests?
2. Is education pathway that focuses on pain management provided in-person and via video in repeated sessions more effective than current standard of care education consisting of a single exposure given as part of a broader preoperative presentation covering multiple topics?
3. Is there a difference between education provided in-person vs video?
4. Does perioperative education improve compliance with multimodal analgesia?
5. Does perioperative education improve appropriate opioid storage?
6. Does perioperative education improve appropriate opioid disposal?

Enrolled patients will be assigned at random to one of 3 study groups. Group 1 (control): Patients are referred to the hospital's standard 1-hour virtual patient education webinar prior to surgery.

Group 2 (in-person): Patients will receive two in-person education sessions (1st session before surgery and 2nd session after surgery). Patients will also receive portable document format (pdf) handouts about opioid and pain management.

Group 3 (video): Patients will receive two video education sessions (1st session before surgery and 2nd session after surgery). Patients will also receive pdf handouts about opioid and pain management.

Detailed Description

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Patients undergoing surgery are frequently unaware of how to properly use opioids for pain management which may result in poor compliance with pain regimens, worse pain control and functional outcomes, and improper storage and disposal. There is evidence that educational interventions in various formats may improve pain and promote proper opioid handling. In addition, multimodal analgesia has been shown to be effective in total joint arthroplasty, and setting appropriate expectations may reduce anxiety, postoperative recovery time, and post surgical acute pain.

The current education process at HSS involves patient referral to a virtual webinar which is optional. Pain topics are covered within a broader 50-minute presentation on numerous topics related to surgery. Information on pain topics may be difficult to process and retain because it is a single exposure that is combined with multiple unrelated topics, and there is no repetition or reference provided. The aim of this study is to explore how a comprehensive educational pathway focusing on aspects of pain control and proper opioid use with repeated sessions will affect outcomes after total knee arthroplasty by comparing three groups - 1) patients who attend the virtual webinar, 2) an in-person session with a portable document format (PDF), and 3) a video session with PDF.

Conditions

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Arthropathy of Knee Post Operative Pain Opioid Use Opioid Abuse Opioid Misuse

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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Control Group

Patients are referred to the Hospital's standard 1-hour virtual patient education webinar prior to surgery.

Group Type NO_INTERVENTION

No interventions assigned to this group

In-person and PDF

Patients will receive two in-person education sessions (1st session before surgery and 2nd session after surgery). Patients will also receive pdf handouts about opioids and pain management.

Group Type EXPERIMENTAL

Opioid education in person

Intervention Type OTHER

The presentation and handouts contain information regarding the following topics:

* Reviewing opioids and strategies for analgesia

* Defining and identifying opioids
* Goals for postoperative pain management and utilizing opioids to treat pain
* Alternative modes of treating pain
* Regional anesthesia/analgesia defined
* Side effects and risks of opioids

* Common side effects of opioids
* Risks of addiction, tolerance, dependence, opioid-induced hyperalgesia with long-term use
* Proper use and handling of opioids

* Safe practices when taking opioids
* Weaning off opioids
* Safe storage and disposal of opioids

Video and PDF

Patients will receive two video education sessions (1st session before surgery and 2nd session after surgery). Patients will also receive pdf handouts about opioids and pain management.

Group Type EXPERIMENTAL

Opioid education via video

Intervention Type OTHER

The video and handouts contain information regarding the following topics:

* Reviewing opioids and strategies for analgesia

* Defining and identifying opioids
* Goals for postoperative pain management and utilizing opioids to treat pain
* Alternative modes of treating pain
* Regional anesthesia/analgesia defined
* Side effects and risks of opioids

* Common side effects of opioids
* Risks of addiction, tolerance, dependence, opioid-induced hyperalgesia with long-term use
* Proper use and handling of opioids

* Safe practices when taking opioids
* Weaning off opioids
* Safe storage and disposal of opioids

Interventions

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Opioid education in person

The presentation and handouts contain information regarding the following topics:

* Reviewing opioids and strategies for analgesia

* Defining and identifying opioids
* Goals for postoperative pain management and utilizing opioids to treat pain
* Alternative modes of treating pain
* Regional anesthesia/analgesia defined
* Side effects and risks of opioids

* Common side effects of opioids
* Risks of addiction, tolerance, dependence, opioid-induced hyperalgesia with long-term use
* Proper use and handling of opioids

* Safe practices when taking opioids
* Weaning off opioids
* Safe storage and disposal of opioids

Intervention Type OTHER

Opioid education via video

The video and handouts contain information regarding the following topics:

* Reviewing opioids and strategies for analgesia

* Defining and identifying opioids
* Goals for postoperative pain management and utilizing opioids to treat pain
* Alternative modes of treating pain
* Regional anesthesia/analgesia defined
* Side effects and risks of opioids

* Common side effects of opioids
* Risks of addiction, tolerance, dependence, opioid-induced hyperalgesia with long-term use
* Proper use and handling of opioids

* Safe practices when taking opioids
* Weaning off opioids
* Safe storage and disposal of opioids

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Age between age 18 and 80 years old
* Undergoing primary total knee replacement surgery at Hospital for Special Surgery
* English speaking

Exclusion Criteria

* History of chronic opioid use (continuous opioid use for 3 or more months)
* Opioid use within the past 3 months
* Contraindication to NSAIDs or acetaminophen
* Contraindication or allergy to opioids
* Contraindication to any study medications (i.e., fentanyl, ketamine, versed, acetaminophen, ketorolac, zofran, decadron)
* Discharge to rehab or skilled nursing facility (opioids are not prescribed by HSS providers)
* Contraindication or refusal to receive neuraxial anesthesia or peripheralnerve blocks (PNB)
* Revision surgery
* Ambulatory surgery
* Patients who are pregnant
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital for Special Surgery, New York

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Bradley H Lee, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital for Special Surgery, New York

Locations

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Hospital for Special Surgery

New York, New York, United States

Site Status

Countries

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United States

References

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Lee BH, Wu CL. Educating Patients Regarding Pain Management and Safe Opioid Use After Surgery: A Narrative Review. Anesth Analg. 2020 Mar;130(3):574-581. doi: 10.1213/ANE.0000000000004436.

Reference Type RESULT
PMID: 31567320 (View on PubMed)

Syed UAM, Aleem AW, Wowkanech C, Weekes D, Freedman M, Tjoumakaris F, Abboud JA, Austin LS. Neer Award 2018: the effect of preoperative education on opioid consumption in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial. J Shoulder Elbow Surg. 2018 Jun;27(6):962-967. doi: 10.1016/j.jse.2018.02.039. Epub 2018 Mar 26.

Reference Type RESULT
PMID: 29599038 (View on PubMed)

Egan KG, De Souza M, Muenks E, Nazir N, Korentager R. Opioid Consumption Following Breast Surgery Decreases with a Brief Educational Intervention: A Randomized, Controlled Trial. Ann Surg Oncol. 2020 Sep;27(9):3156-3162. doi: 10.1245/s10434-020-08432-7. Epub 2020 Apr 13.

Reference Type RESULT
PMID: 32285282 (View on PubMed)

Horn A, Kaneshiro K, Tsui BCH. Preemptive and Preventive Pain Psychoeducation and Its Potential Application as a Multimodal Perioperative Pain Control Option: A Systematic Review. Anesth Analg. 2020 Mar;130(3):559-573. doi: 10.1213/ANE.0000000000004319.

Reference Type RESULT
PMID: 31335400 (View on PubMed)

Memtsoudis SG, Poeran J, Zubizarreta N, Cozowicz C, Morwald EE, Mariano ER, Mazumdar M. Association of Multimodal Pain Management Strategies with Perioperative Outcomes and Resource Utilization: A Population-based Study. Anesthesiology. 2018 May;128(5):891-902. doi: 10.1097/ALN.0000000000002132.

Reference Type RESULT
PMID: 29498951 (View on PubMed)

Stepan JG, Sacks HA, Verret CI, Wessel LE, Kumar K, Fufa DT. Standardized Perioperative Patient Education Decreases Opioid Use after Hand Surgery: A Randomized Controlled Trial. Plast Reconstr Surg. 2021 Feb 1;147(2):409-418. doi: 10.1097/PRS.0000000000007574.

Reference Type RESULT
PMID: 33235041 (View on PubMed)

Nahhas CR, Hannon CP, Yang J, Gerlinger TL, Nam D, Della Valle CJ. Education Increases Disposal of Unused Opioids After Total Joint Arthroplasty: A Cluster-Randomized Controlled Trial. J Bone Joint Surg Am. 2020 Jun 3;102(11):953-960. doi: 10.2106/JBJS.19.01166.

Reference Type RESULT
PMID: 32251139 (View on PubMed)

Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005 Aug 4;353(5):487-97. doi: 10.1056/NEJMra050100. No abstract available.

Reference Type RESULT
PMID: 16079372 (View on PubMed)

Sheetz M, Puglisi A, Trentalange M, Reichel J, Chalmers B, Gonzalez Della Valle A, Sideris A, Lee BH. Comparing modalities of opioid education in patients undergoing total knee arthroplasty: a randomized pilot trial. Reg Anesth Pain Med. 2024 Sep 26:rapm-2024-105701. doi: 10.1136/rapm-2024-105701. Online ahead of print.

Reference Type DERIVED
PMID: 39327049 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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2022-1286

Identifier Type: -

Identifier Source: org_study_id