Efficacy of Adding Acetaminophen to Preemptive Multimodal Analgesia in Total Knee Arthroplasty: A Double‐blinded Randomized Study

Abstract

ObjectivePreemptive multimodal analgesia is a frequently utilized method for controlling pain after total knee arthroplasty (TKA). So far, no studies have specifically examined the efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA. The current work aimed to assess the efficacy of adding acetaminophen to preemptive multimodal analgesia for clinical pain management after TKA.MethodsThis was a double‐blinded randomized study including 80 cases randomized to the acetaminophen and control groups, respectively. The acetaminophen group was administered celecoxib at 400 mg, pregabalin at 150 mg, and acetaminophen at 300 mg 2 h before TKA. Control patients were administered celecoxib, pregabalin, and placebo. The primary outcome was postsurgical use of morphine hydrochloride for rescue analgesia. Secondary outcomes included the time to the initial rescue analgesia, postsurgical pain as determined by a visual analogue scale (VAS), functional recovery as reflected by the range of knee motion and ambulation distance, hospitalization duration, and complication rates. Continuous data with normal and skewed distributions were compared by the Student's t test and the Mann–Whitney U test, respectively. Categorical variables were compared by the Pearson's chi‐squared test.ResultsThe control and acetaminophen groups were comparable in postoperative 0–24 h morphine consumption (11.3 ± 6.5 mg vs 12.3 ± 7.7 mg, P = 0.445) and total morphine consumption (17.3 ± 10.1 mg vs 19.3 ± 9.4 mg, P = 0.242). Additionally, time to the initial rescue analgesia, postoperative VAS score at any time point, postoperative functional recovery of the knee, and hospitalization duration were similar in both groups. Both groups also had similar occurrence rates of postoperative complications.ConclusionsIn this study, adding acetaminophen to preoperative preemptive multimodal analgesia did not decrease postoperative morphine use or ameliorate pain relief. The efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA need to be further explored in future studies.

Efficacy of postoperative analgesia with intravenous paracetamol and mannitol injection, combined with thoracic paravertebral nerve block in post video-assisted thoracoscopic surgery pain: a prospective, randomized, double-blind controlled trial

“…In our study, the patients received a recommended dosage of 500 mg of paracetamol and mannitol injection before one-lung ventilation, with two additional dosage administered 24 h after surgery. In a previous study of total knee arthroplasty, there was no clinical improvements or benefits in patients administered preemptive acetaminophen [ 14 ]. However, a retrospective study including 1416 patients revealed that the pretreatment of acetaminophen and gabapentin 30–60 min prior to operation reduced postoperative opioid requirements and pain [ 28 ].…”

“…Paracetamol exerts its analgesic effects via different pathways, including the inhibition of COX-2-dependent prostaglandin E2 synthesis, indirectly activating CB1 and TRPV1 receptors in the brain through its metabolites AM404 [ 11 , 12 ]. Multiple studies have shown the positive effect of paracetamol on postoperative pain management in various procedures, including orthopedic surgery, radical mastectomy, cholecystectomy, cesarean section and abdominal hysterectomy [ 13 , 14 ]. However, a previous study involving women receiving hysterectomy revealed that intravenous acetaminophen did not decrease narcotic use or postoperative pain compared with the group that received the placebo [ 15 ].…”

Efficacy of Diosmin in Reducing Lower-Extremity Swelling and Pain After Total Knee Arthroplasty

“…We obtained this information prior to patient enrollment from patients who were not included in the trial. The materials and methods are partially based on previous studies 22-24 .…”