title: Pain reporting, opiate dosing, and the adverse effects of opiates after hip or knee replacement in patients 60 years old or older.
abstract: Our goal was to determine whether there were age-related differences in pain, opiate use, and opiate side effects after total hip or knee arthroplasty in patients 60 years old or older. We hypothesized that there would be no significant differences between age groups in (1) mean pain score, (2) opiate use after adjusting for pain, or (3) opiate side effects after adjusting for opiate use and pain score. We retrospectively reviewed the electronic and paper charts of all patients undergoing total joint replacements at our institution over 3 years who met the following criteria: (1) 60 years old or older, (2) primary single total knee or total hip replacement, and (3) no preoperative dementia. Preoperative, intraoperative, and postoperative course data were collected using a customized data entry process and database. We divided the patients into 2 age groups, those 60 to 79 years old and those 80 years old or older. Using a marginal model with the panel variable of postoperative day, we investigated the associations between age group and pain, age group and pain adjusting for opiate use, and age group and complications (respiratory depression, naloxone usage as a measure of respiratory arrest, delirium, constipation, and urinary retention) adjusting for opiate use (Xtgee, Stata10, Stata Corp. LP, College Station, Texas). Significance was set at P < .05. We found no significant difference in pain scores between groups, but the older group had significantly fewer opiates prescribed yet significantly more side effects, including delirium (odds ratio 4.2), than did the younger group, even after adjusting for opiate dose and pain score.
authors.affiliation: Department of Orthopaedic Surgery, International Center for Orthopaedic Advancement, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Petre
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Roxbury
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: McCallum
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Defontes
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Belkoff
authors.forename: Simon C
authors.initials: SC
authors.lastname: Mears
keywords: elderly; hip replacement; knee replacement; opiates; pain