Opiate abuse is a rapidly growing epidemic in the US, and orthopaedic surgeons are among the highest prescribers. While surgeons have relied heavily on opiates after total hip replacement (THR), our goal was to determine whether a multimodal pain regimen could improve pain control and reduce or even obligate the need for opiates. In a cluster-randomised, crossover trial, we assigned 235 patients undergoing THR to receive either a multimodal pain regimen with a minimal opiate supply (Group A- 10 tablets only), a conventional multimodal regimen (Group B- 60 tablets), or a traditional opiate regimen without multimodal therapy (Group C- 60 tablets). Clusters were determined by surgeon, with each cluster alternating between regimens in 4-week intervals. The multimodal pain regimen comprised standing-dose acetaminophen, meloxicam, and gabapentin. Primary outcomes were VAS pain and daily opiate use for the first 30 days postoperatively. Secondary outcomes included daily assessments of satisfaction, sleep quality, and opiate-related symptoms, hip function at 1-month, and 90-day adverse events.Background
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