Dextromethorphan Use in Multimodal Analgesia Regimens for Total Knee Arthroplasty

Summary

Total knee arthroplasty (TKA) is one of the most painful orthopedic procedures. After TKA surgery, postoperative pain relief may be achieved using a variety of techniques. Integral to recovery and improved outcomes is early ambulation and mobilization. Achieving adequate postoperative pain control while ensuring the ability to ambulate early can be quite challenging.

Currently, in our country there has been a call to address prescription opioid use and abuse due to a nationwide opioid epidemic. In light of this, improving our multimodal analgesic protocol will serve to decrease reliance of opioid medications for pain control. Multimodal analgesia is effective in decreasing total opioid consumption postoperatively. Dextromethorphan is a low-affinity noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist. It has a long history of clinical use with an established safety record. Studies have shown that it has a positive effect as an analgesic.

In order to see if dextromethorphan will decrease opioid use, this study will look at two patient groups undergoing total knee arthroplasty with the same preoperative, intraoperative, and postoperative anesthetic plan with the exception of the addition of dextromethorphan to one groups multimodal analgesic regimen. This study is designed as a double-blinded, randomized, prospective cohort trial.

Conditions

• Pain, Postoperative

Interventions

DRUG

Dextromethorphan

Additional medication to perioperative analgesic regimen in Group B

DRUG

Placebo - Concentrate

Additional medication to perioperative analgesic regimen to Group A

DRUG

Acetaminophen

Multimodal analgesic regimen to Group A and Group B

DRUG

Oxycodone

Multimodal analgesic regimen to Group A and Group B

DRUG

Celecoxib

Multimodal analgesic regimen to Group A and Group B

DRUG

Pantoprazole

Multimodal analgesic regimen to Group A and Group B

DRUG

Ketorolac

Multimodal analgesic regimen to Group A and Group B

DRUG

Gabapentin

Multimodal analgesic regimen to Group A and Group B

DRUG

Hydromorphone

Multimodal analgesic regimen to Group A and Group B

Sponsors & Collaborators

• University of Southern California

  lead OTHER

Principal Investigators

• Hanna Schittek, MD · University of Southern California

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2017-01-31

Primary Completion

2018-01-31

Completion

2018-01-31