A Prospective Evaluation of 2 Different Pain Management Protocols for Total Hip Arthroplasty

Post, Zachary D.; Restrepo, Camilo; Kahl, Lauren K.; Leur, Tim van de; Purtill, James J.; Hozack, William J.

doi:10.1016/j.arth.2010.01.003

Cited by 40 publications

(23 citation statements)

References 11 publications

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“…Apart from delayed hospital discharge, patient dissatisfaction, and poorer clinical outcomes, chronic opioid use has been well documented to negatively impact patient ability to return to work and lead a productive, independent life [29][30][31][32]. Kidner et al evaluated 1,226 patients at acute rehabilitation facilities who were admitted for treatment of chronic musculoskeletal conditions and were treated with opioid analgesics [33].…”

Section: Discussionmentioning

confidence: 99%

Opioid use prior to total hip arthroplasty leads to worse clinical outcomes

Pivec

Issa

Naziri

et al. 2014

International Orthopaedics (SICOT)

182

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Purpose The purpose of this study was to compare the clinical outcomes of patients undergoing total hip arthroplasty (THA) who had been using narcotic medications prior to surgery to those who had not used them. Methods Fifty-four patients (62 hips) who had required opioid analgesia for hip pain in the three months prior to THA were compared to a matched group of opioid-naïve patients. Narcotic consumption was converted to a standardized morphine equivalent dose and compared between both groups of patients during their hospital stay, after six weeks, and at final follow-up. Other outcome measures included clinical outcome scores and the proportion of patients remaining on narcotic pain medication at final follow-up. Results The narcotic group required significantly higher total daily opioid doses as inpatients had a longer hospital stay and a higher proportion of patients who remained on opioids at six weeks and at final follow-up. Of the patients who were taking opioids pre-operatively, 81 % were able to wean off opioids at final follow-up. At a mean post-operative follow-up of 58 months (range, 24-258 months), Harris hip scores were lower in the narcotic group, with a mean of 84 compared to 91 points in the matching group. However, in both cohorts, there were significant improvements in Harris hip scores compared to pre-operative outcomes.

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Section: Discussionmentioning

confidence: 99%

Opioid use prior to total hip arthroplasty leads to worse clinical outcomes

Pivec

Issa

Naziri

et al. 2014

International Orthopaedics (SICOT)

182

View full text Add to dashboard Cite

show abstract

“…Multimodal analgesia with non-steroidal anti-inflammatory drugs in patients with adequate renal function is reported to be as effective as opioid analgesia with fewer side effects (O'Hara et al 1997;Post et al 2010). When using multimodal analgesia, it is especially important to take early advice from the patient's neurologist for potential adverse interaction between the type of analgesic protocol used and the neurological medication regime.…”

Section: Post -Operative Management 231 Analgesic Managementmentioning

confidence: 99%

Joint Replacement Surgery in Parkinson's Disease

Cassar-Gheiti¹,

Baker²,

Mulhall³

2011

Diagnostics and Rehabilitation of Parkinson's Disease

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“…26 In addition, compared with patient-controlled analgesia using morphine alone, a multimodal analgesic regimen that included pregabalin 75 mg before surgery and pregabalin 75 mg twice daily (BID) for 48 h produced equal levels of satisfactory pain control and fewer adverse effects. 27 However, there is a lack of consensus regarding the appropriate dose or timing of pregabalin administration required to improve acute and postdischarge postoperative pain and physical functioning after surgery. We conducted this randomized, double-blind, placebocontrolled study to examine whether the addition of pregabalin to our perioperative THA analgesic regimen in the perioperative period and for 7 days after discharge improves pain and functional outcomes up to 3 months after surgery.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

Pregabalin Reduces Postoperative Opioid Consumption and Pain for 1 Week After Hospital Discharge but Does Not Affect Function at 6 Weeks or 3 Months After Total Hip Arthroplasty

Clarke

Pagé

McCartney

et al. 2016

Survey of Anesthesiology

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Background: This study examined whether a perioperative regimen of pregabalin added to celecoxib improved pain scores and functional outcomes postdischarge up to 3 months after total hip arthroplasty (primary outcome) and acute postoperative pain and adverse effects (secondary outcomes). Methods: One hundred and eighty-four patients were enrolled in a randomized, double-blind, placebo-controlled study. Two hours before receiving a spinal anaesthetic and undergoing surgery, patients received celecoxib 400 mg p.o. and were randomly assigned to receive either pregabalin 150 mg p.o. or placebo p.o. After surgery, patients received pregabalin 75 mg or placebo twice daily in hospital and for 7 days after discharge. Patients also received celecoxib 200 mg every 12 h for 72 h and morphine i.v. patient-controlled analgesia for 24 h. Pain and function were assessed at baseline, 6 weeks, and 3 months after surgery. Results: There was no difference between groups in physical function or incidence and intensity of chronic pain 3 months after total hip arthroplasty. The pregabalin group used less morphine [mean (): 39.85 (28.1) mg] than the placebo group [54.01 (31.2) mg] in the first 24 h after surgery (P<0.01). Pain scores were significantly lower in the pregabalin group vs the placebo group on days 1-7 after hospital discharge, and the pregabalin group required less adjunctive opioid medication (Percocet) 1 week after hospital discharge (P<0.05). Conclusions: Perioperative administration of pregabalin did not improve pain or physical function at 6 weeks or 3 months after total hip arthroplasty. Perioperative administration of pregabalin decreased opioid consumption in hospital and reduced daily pain scores and adjunct opioid consumption for 1 week after discharge.

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A Prospective Evaluation of 2 Different Pain Management Protocols for Total Hip Arthroplasty

Cited by 40 publications

References 11 publications

Opioid use prior to total hip arthroplasty leads to worse clinical outcomes

Opioid use prior to total hip arthroplasty leads to worse clinical outcomes

Joint Replacement Surgery in Parkinson's Disease

Pregabalin Reduces Postoperative Opioid Consumption and Pain for 1 Week After Hospital Discharge but Does Not Affect Function at 6 Weeks or 3 Months After Total Hip Arthroplasty

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