J Arthroplasty. 2022 Apr 4:S0883-5403(22)00383-7. doi: 10.1016/j.arth.2022.03.081. Online ahead of print.
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 vs. EO: 51.0 ± 18.2; p=0.013). No significant differences existed for VAS scores at other times, and no significant differences were observed for postoperative NRS sleep scores or postoperative opioid use at any time point.
CONCLUSIONS: 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 the local effects of topical CBD are not beneficial for providing additional pain relief after TKA.