Rethinking Pain Relief After Surgery: What We Can Learn from Knee Replacements.

Abstract

This paper offers a clear, evidence-based look at how we can reduce opioid use after knee replacement surgery without sacrificing pain relief. This review focuses specifically on total knee arthroplasty (TKA)-one of the most commonly performed and most painful surgeries-and asks whether opioids are truly necessary. By analyzing results from 21 clinical trials, the paper shows that non-opioid medications like NSAIDs and gabapentinoids can provide similar pain control with fewer side effects, such as nausea, dizziness, constipation, and sedation. Lower risk of long-term use is an added benefit. A recent RCT found that after knee/shoulder arthroscopy, 72% of patients in an opioid-sparing protocol remained opioid-free over six weeks-compared to just 5.4% in the traditional opioid group.⁸ Given how many people receive their first opioid prescription after surgery, the findings have major public health implications. They highlight a growing opportunity for clinicians and hospitals to shift away from default opioid prescribing toward safer, evidence-based pain management protocols. This transition is not only clinically feasible, but also urgently needed to reduce unnecessary opioid exposure, prevent avoidable side effects, and lower the risk of long-term use or diversion. With the right combination of education, clinical tools, and system-level support, many surgical patients may recover successfully with minimal or no opioid use when supported by effective multimodal protocols.