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

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.

• Authors: Thomas R Hickernell, Akshay Lakra, Ari Berg, Herbert J Cooper, Jeffrey A Geller, Roshan P Shah
• Journal: The Journal of arthroplasty (J Arthroplasty) Vol. 33 Issue 12 Pg. 3637-3641 (12 2018) ISSN: 1532-8406 [Electronic] United States
• PMID: 30170713 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Chemical References

• Analgesics, Opioid
• Cannabinoid Receptor Agonists
• Cannabinoids
• Morphine
• Dronabinol

Topics

• Aged
• Aged, 80 and over
• Analgesics, Opioid (administration & dosage)
• Arthroplasty, Replacement, Hip (adverse effects)
• Arthroplasty, Replacement, Knee (adverse effects)
• Cannabinoid Receptor Agonists (therapeutic use)
• Cannabinoids (therapeutic use)
• Clinical Protocols
• Cohort Studies
• Dronabinol (therapeutic use)
• Female
• Humans
• Length of Stay
• Male
• Middle Aged
• Morphine (administration & dosage)
• Pain Management
• Pain Measurement
• Pain, Postoperative (etiology, prevention & control)
• Patient Satisfaction
• Physical Therapy Modalities
• Retrospective Studies