The Efficacy of Preoperative Video-Based Opioid Counseling on Postoperative Opioid Consumption after Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Introduction There are myriad strategies to reduce opioid consumption after total knee arthroplasty (TKA). Recent studies have suggested that preoperative counseling may reduce opioid use after a variety of orthopaedic procedures. The purpose of this study was to investigate whether preoperative video-based patient education regarding opioid use and abuse reduces opioid consumption after TKA. Methods In this prospective randomized controlled trial, patients were randomized before TKA to either receive preoperative video-based counseling or not. Counseling involved a pre-taped 5-minute video that educated patients on statistics regarding the “opioid epidemic” and discussed safe use and alternatives to opioids after TKA. There were no significant differences in baseline patient demographics between groups. All patients received a similar multimodal perioperative pain management protocol and completed a daily diary for two weeks postoperatively. Diary records measured pain levels using a visual analog score (VAS), opioid consumption, side effects experienced, and patient opinion and satisfaction regarding their pain control. Results Patients in the counseling group consumed significantly less morphine milligram equivalents (MMEs) on postoperative days (PODs) 0-3 (78.8 versus 106.1, P = 0.020) and in week one postoperatively (129.9 versus 180.7, P = 0.028), with a trend of less consumption over two weeks postoperatively (186.9 versus 239.1, P = 0.194). There were no significant differences in the number of patients requiring refills, side effects, or daily pain levels between the two groups. Conclusion This study found significantly decreased opioid consumption within the first week after TKA in patients who received preoperative video counseling.