Topical CBD did not reduce postsurgical opioid consumption after total knee arthroplasty. Utilization of topical CBD in supplement to multimodal analgesia did not reduce pain or opioid consumption, or improve sleep scores following TKA. These results suggest that the local effects of topical CBD are not beneficial for providing additional pain relief after TKA.
Topical Cannabidiol Did Not Reduce Opioid Consumption After Knee Arthroplasty
Cannabis salve with hemp and CBD oil and marijuana leaves on green background Local effects of topical CBD may not provide additional pain relief after knee arthroplasty.
After total knee arthroplasty (TKA), topical cannabidiol (CBD) did not reduce pain or opioid consumption, according to results of a randomized double-blind, placebo-controlled study, published in The Journal of Arthroplasty.
Patients (N=90) undergoing primary unilateral TKA between 2020 and 2021 at Thomas Jefferson University in the United States were recruited for this study. Patients were randomized in a 1:1:1:1 ratio to receive CBD alone (n=19), essential oils (EO) alone (n=21), CBD with EO (n=21), or placebo (n=19).
After the TKA procedure, patients were instructed to apply the topical formulation after the anesthesia wore off and to continue to apply the formulation 3 times per day until postoperative day 14. The primary outcomes were postoperative pain, opioid use, sleep scores, extremity functional scores, and patient-reported outcomes.
The patient cohorts were aged mean 64.1-67.3 years, 36.8%-57.1% were men, 85.7%-95.2% were White, 61.9%-78.9% received a cruciate retaining implant, the length of surgery was 70.1-73.8 minutes, length of hospital stay was 25.7-27.0 hours, and time to first narcotic use was 5.25-7.90 hours.
Cohort mean preoperative pain ranged from 48.3-54.4 points on a visual analogue scale (VAS) and did not differ between groups (P =.781). On postoperative day 1, pain scores ranged from 28.1-32.9 points (P =.809), increasing during the first 2 weeks after surgery and returning to 20.2 to 29.6 points on postoperative day 42 (P =.675). The only difference in pain scores between groups was observed on postoperative day 2, in which the EO recipients reported lower pain scores (mean, 51.0 vs 61.0-69.9 points; P =.026).
No significant group differences were observed for opioid consumption or sleep scores.
For functional outcomes, placebo recipients had higher Lower Extremity Function Scale (LEFS) scores on postoperative day 14 (mean, 42.5 vs 30.1-37.8; P =.050) and EO recipients had higher Short Form 12-Item Physical Component Score (SF-12 PCS) on postoperative day 42 (mean, 39.4 vs 30.6-35.7; P =.021).
In the multiple comparison analysis, EO was favored over CBD for VAS scores on postoperative day 2 (P =.013), CBD was favored over placebo for LEFS scores on postoperative day 14 (P =.040), and CBD-EO was favored over EO for SF-12 PCS on postoperative day 42 (P =.010).
No patients reported a reaction to the topical placebo or CBD-EO formulations. One patient in each group reported a mild erythematous reaction to the CBD and EO formulations. The patient who had a reaction to the EO formulation discontinued use.
One patient randomized to receive placebo was readmitted to the hospital due to shortness of breath.
This study was limited by not monitoring patient use of the topical formulation.
These findings did not support the use of topical CBD for reducing pain or opioid consumption following TKA.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Topical Cannabidiol (CBD) After Total Knee Arthroplasty Does Not Decrease Pain or Opioid Use: A Prospective Randomized Double-Blinded Placebo-Controlled Trial
Background: Multimodal analgesia has become the standard of care for pain management following total knee arthroplasty (TKA). Cannabidiol (CBD) is increasingly utilized in the postoperative period. The purpose of this study was to analyze the analgesic benefits of topical CBD following primary TKA.
Methods: In this randomized double-blinded placebo-controlled trial, 80 patients undergoing primary unilateral TKA applied topical CBD (CBD; n = 19), essential oil (EO; n = 21), CBD and essential oil (CBD + EO; n = 21), or placebo (PLA; n = 19) thrice daily around the knee for two weeks postoperatively. This supplemented a standardized multimodal analgesic protocol. Outcomes included visual analog scale (VAS) pain and numeric rating scale (NRS) sleep scores (collected on postoperative day [POD] 0, 1, 2, 7, 14, 42), and cumulative postoperative opioid use (42 days).
Results: Demographic characteristics were similar among the four cohorts. Preoperative VAS and NRS scores were similar among groups. The CBD cohort had a higher mean VAS pain score on POD 2 compared to the EO cohort (CBD: 69.9 ± 19.3 versus. EO: 51.0 ± 18.2; P = .013). No statistically significant differences existed for VAS scores at other times, and no statistically significant differences were observed for postoperative NRS sleep scores or postoperative opioid use at any time point.
Conclusion: Utilization of topical CBD in supplement to multimodal analgesia did not reduce pain or opioid consumption, or improve sleep scores following TKA. These results suggest that the local effects of topical CBD are not beneficial for providing additional pain relief after TKA.
Keywords: analgesia; cannabidiol (CBD); cannabis; opioid; total knee arthroplasty.
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YaDeau JT, Mayman DJ, Jules-Elysee KM, Lin Y, Padgett DE, DeMeo DA, Gbaje EC, Goytizolo EA, Kim DH, Sculco TP, Kahn RL, Haskins SC, Brummett CM, Zhong H, Westrich G. YaDeau JT, et al. J Arthroplasty. 2022 Jun;37(6S):S147-S154. doi: 10.1016/j.arth.2022.02.022. Epub 2022 Feb 18. J Arthroplasty. 2022. PMID: 35346549 Clinical Trial.
Wang Q, Hu J, Zeng Y, Li D, Yang J, Kang P. Wang Q, et al. J Arthroplasty. 2021 Oct;36(10):3421-3431. doi: 10.1016/j.arth.2021.05.014. Epub 2021 May 19. J Arthroplasty. 2021. PMID: 34090689 Clinical Trial.
Tziona D, Papaioannou M, Mela A, Potamianou S, Makris A. Tziona D, et al. J Anesth. 2018 Jun;32(3):326-332. doi: 10.1007/s00540-018-2476-x. Epub 2018 Mar 5. J Anesth. 2018. PMID: 29508066 Clinical Trial.
Chai X, Liu H, You C, Wang C. Chai X, et al. Pain Pract. 2019 Mar;19(3):316-327. doi: 10.1111/papr.12740. Epub 2019 Jan 1. Pain Pract. 2019. PMID: 30354013 Review.
Chaturvedi R, Tram J, Chakravarthy K. Chaturvedi R, et al. Pain Manag. 2022 Jan;12(1):105-116. doi: 10.2217/pmt-2020-0107. Epub 2021 Sep 23. Pain Manag. 2022. PMID: 34551582 Review.