Opioid Reduction in Orthopaedic Surgery (OREOS) - Knees

Summary

Knee replacements are the second most common surgery in Canada. Most patients recover very well but research consistently shows that 1 in 5 patients still have pain many months after surgery. Doctors often prescribe opioid medications for pain after surgery (e.g. Percocet, hydromorphone, codeine). These medications can be helpful for some people, but they can also be dangerous, particularly when used for a long time. Many patients don't like the way opioids make them feel and would prefer alternative pain management strategies. Some people become addicted to opioids, have a difficult time reducing the dose of opioids, or have lasting health problems after using them.

People in this study will be randomized to either have usual care or a new pathway designed to improve pain control and decrease opioid use after knee replacements. This study will have an intervention coordinator who will assess patients before surgery and who will follow up with patients regularly after surgery to make sure their pain is controlled and to avoid long-term opioid use. This study will use education, physiotherapy, psychological therapy, ice/cold, and non-opioid pain medications. As pain medications may work differently in different patients, the coordinator will check on each patient to look for pain control and assist to reduce the amount of opioids used after surgery.

This study will help people have safer and more effective pain management after surgery which may lead to better recovery, higher satisfaction, and a lower risk of being harmed by opioids after surgery.

Conditions

• Knee Osteoarthritis
• Chronic Post Operative Pain

Interventions

OTHER

Multicomponent opioid reduction and pain management pathway

Pre-operative pain education and expectation setting, identification and modification of risk factors in high risk patients, postoperative individualized analgesic prescriptions, and continued support for pan control and recovery facilitated by an interventions coordinator.

OTHER

Standard care

Standard perioperative care, surgical treatment, and pain medications.

Sponsors & Collaborators

• St. Joseph's Healthcare Hamilton

  collaborator OTHER

• McMaster Surgical Associates

  collaborator OTHER

• St. Joseph's Healthcare Foundation

  collaborator OTHER

• Kim Madden

  lead OTHER

Principal Investigators

• Harsha Shanthanna, MD PhD FRCPC · McMaster University

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2022-03-09

Primary Completion

2024-07-14

Completion

2024-07-14

Countries

• Canada

Study Locations