Drug Utilization for Pain Management during Perioperative Period of Total Knee Arthroplasty in China: A Retrospective Research Using Real-World Data

Abstract

Background and Objective: Total knee arthroplasty (TKA) is one of the most painful procedures and perioperative pain usually requires the use of many analgesics to relieve it. The appropriate use of analgesics to relieve patient pain is an important issue of TKA. To characterize the drug utilization for pain management during perioperative period of TKA in China using real-world data of electronic medical records. Materials and Methods: This research used the data of all inpatients who received TKA at 145 hospitals covered 31 provinces in China from 1 January 2016 to 31 December 2018. The exclusion criteria included pregnancy and cancer diagnosis. In the analysis of drug utilization mode (DUM), medicines were classified into 5 groups: non-steroidal anti-inflammatory drugs (NSAIDs), opioids, non-opioid central analgesics, acetaminophen and others. Results: Among the 2017 patients included in this study, there were 1537 (76.20%) female and 480 (23.80%) male, aged 65.77 ± 7.73 years. Regarding the surgery characteristics, 1658 (82.20%) were unilateral; 1220 (60.49%) was graded Level 4; 1312 (65.05%) used local anesthesia as the main anesthesia method, and 1450 (71.89%) lasted for more than 2 h. The most common DUM was “NSAIDs + opioids” (55.92%), followed by “NSAIDs only” (17.85%), and “NSAIDs + Opioids + Non-opioid central analgesics” (17.15%). The results of the Chi-square test showed that differences in DUM were associated with surgery types, surgery levels, surgery duration, and types of anesthesia used. Up to 81.14% of the total drug expenses for pain management was spent on NSAIDs. Due to the limitation of database, this study could not subdivide operation stages, anesthesia methods, dosage forms of drugs. Conclusion: In China, the use of analgesics in perioperative period of TKA was diversified and influenced by a number of surgery characteristics. The rational use of analgesics should be considered in combination with surgery type, surgery level, surgery duration and anesthesia method.

Continuous Lumbar Plexus Block under the Guidance of the “Shamrock Method” Ultrasound: Analgesic Effects and Hemodynamic Effects after Total Knee Arthroplasty in Elderly Patients

“…With the aging of the population, degenerative diseases of joints are also increasing. Total knee arthroplasty (TKA) is a major technique for the treatment of severe knee joint disorders and the reconstruction of knee function, which can relieve knee pain and reconstruct knee function [ 1 ]. However, TKA is traumatic, and the patient's stress response is great, which often leads to severe postoperative pain, thus affecting the recovery of patients to some extent.…”

A Review on the Efficacy of Extraosseous Local Infiltration of Multimodal Drug Cocktail for Pain Management After Total Knee or Hip Arthroplasty

“…Chen et al in their retrospective study observed that there were numerous postoperative usages of modes of analgesia for patients who have undergone TKA to control their pain. The type of operation, the level of surgery, the length of the surgery, and the anesthesia technique may all need to be taken into account when deciding whether to utilize analgesics [ 36 ]. Martin et al in their study stated that the post-operative healing following in total knee replacement has been revolutionized by the use of a combination of an efficient, technologically well-driven periarticular cocktail injection, a multimodal supplemental pain program, as well as the application of tranexamic acid to limit bleeding.…”