Evolution of an Opioid Sparse Pain Management Program for Total Knee Arthroplasty With the Addition of Intravenous Acetaminophen

Yu, Stephen; Eftekhary, Nima; Wiznia, Daniel H.; Schwarzkopf, Ran; Long, William J.; Bosco, Joseph; Iorio, Richard

doi:10.1016/j.arth.2019.08.013

Cited by 17 publications

(15 citation statements)

References 27 publications

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“…[ 5 , 6 ] Several pain relief methods are available for postoperative analgesia, including patient-controlled intravenous analgesia, intravenous opioids, femoral nerve block, local infiltration analgesia, and epidural. [ 7 – 10 ] However, the most suitable analgesic method remains controversial. Recently, published studies have reported that the adductor canal block (ACB) provides effective postoperative analgesia.…”

Section: Introductionmentioning

confidence: 99%

Is the proximal adductor canal block a better choice than the distal adductor canal block for primary total knee arthroplasty?

Zhang

Chen

et al. 2020

Medicine

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Background: Total knee arthroplasty is accompanied by moderate to severe postoperative pain. Postoperative pain hampers the functional recovery and lowers patient satisfaction with the surgery. Recently, the adductor canal block (ACB) has been widely used in total knee arthroplasty. However, there is no definite answer as to the location of a continuous block within the ACBs. Method: Randomized controlled trials about relevant studies were searched in PubMed (1996 to Oct 2019), Embase (1996 to Oct 2019), and Cochrane Library (CENTRAL, Oct 2019). Results: Five studies involving 348 patients met the inclusion criteria. Pooled data indicated that the proximal ACB was as effective as the distal ACB in terms of total opioid consumption ( P = .54), average visual analog scale (VAS) score ( P = .35), worst VAS score ( P = .19), block success rate ( P = .86), and time of catheter insertion ( P = .54). Conclusions: Compared with the distal ACB, the proximal ACB showed similar analgesic efficacy for total opioid consumption, average VAS score, worst VAS score, block success rate, and time of catheter insertion. However, because of the limited number of involved studies, more high-quality studies are needed to further identify the optimal location of the ACB.

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Section: Introductionmentioning

confidence: 99%

Is the proximal adductor canal block a better choice than the distal adductor canal block for primary total knee arthroplasty?

Zhang

Chen

et al. 2020

Medicine

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“…While the three other studies did not find significant differences between the two groups, due to the much larger sample size of the study performed by Yu et al (2020), an overall significant difference was found in the meta-analysis. Overall, those receiving IV paracetamol required 5.6mg (95% CI 4.38-6.83) less OMEs in the first 24h postoperatively, shown in Figure 3.…”

Section: Postoperative Analgesic Requirementsmentioning

confidence: 60%

“…However, of these differences, only that reported by Yu et al (2020) was statistically significant. Yu et al (2020) reported a pain score of four in the intravenous group and a pain score of two in the oral group.…”

Section: Postoperative Pain Scoresmentioning

confidence: 99%

“…Four studies reported postoperative analgesia requirements, in milligrams of oral morphine equivalent (OME). One study (Yu et al 2020) found a statistically significant difference in analgesic requirements, with those receiving oral paracetamol receiving a mean of 13.3mg and those receiving IV paracetamol receiving a mean of 6.2mg (P < 0.001).…”

Section: Postoperative Analgesic Requirementsmentioning

confidence: 99%

See 1 more Smart Citation

Intravenous versus oral paracetamol for postoperative analgesia: A systematic review

Stagg

2020

Journal of Perioperative Practice

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Paracetamol is a widely used analgesic agent that can be given by several different routes of administration. In the surgical setting, intravenous infusions of paracetamol are used, but an alternative is using oral paracetamol as a premedication. This systematic review is the first to compare the relative efficacy of intravenous and oral paracetamol at providing postoperative analgesia. Nine relevant studies were identified. Intravenous paracetamol resulted in a postoperative pain score of 0.5 points lower than in those receiving oral paracetamol premedication. Patients receiving intravenous paracetamol also had a small reduction in postoperative opioid requirements, but the time at which rescue analgesia was required did not differ. These results suggest that intravenous paracetamol may offer a small advantage over oral paracetamol premedication at providing postoperative analgesia.

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“…Multiple studies have demonstrated the opioid-sparing effects of acetaminophen and non-steroidal anti-inflammatory agents. [6][7][8][9] Although the gabapentenoids have reported opioid sparing effects, recent meta-analysis have failed to demonstrate beneficial effect in the perioperative period. [7,10] However, due to the limited availability of other nonopioid analgesic agents we elected to utilize gabapentenoids for this protocol.…”

Section: Plos Onementioning

confidence: 99%

Impact of a perioperative oral opioid substitution protocol during the nationwide intravenous opioid shortage: A single center, interrupted time series with segmented regression analysis

et al. 2020

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Introduction To mitigate the recent nationwide shortage of intravenous opioids, we developed a standardized perioperative oral opioid guideline anchored with appropriate use of nonopioid analgesia, neuraxial and loco-regional techniques. We hypothesize that adoption of this new guideline was associated with: 1) equivalent patient reported pain scores in the postanesthesia care unit (PACU); and 2) equivalent total opioid use (oral and parenteral) during the perioperative period. Methods Cases performed from July 1, 2017 to May 31, 2019 were screened. All opioids administered were converted to intravenous morphine milligram equivalents. Segmented regression analyses of interrupted time series were performed examining the change in opioid use, PACU pain scores and number of non-opioid analgesic medications used before and after the protocol implementation in April 2018. Results After exclusions, 29, 621 cases were included in the analysis. No significant differences in demographic, ASA status, case length and surgical procedure type were present in the pre and post-intervention period. A significant decrease in total (Estimate:-39.9 mg, SE: 6.9 mg, p < 0.001) and parenteral (Estimate:-51.6 mg, SE: 7.1 mg, p < 0.001) opioid use with a

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Evolution of an Opioid Sparse Pain Management Program for Total Knee Arthroplasty With the Addition of Intravenous Acetaminophen

Cited by 17 publications

References 27 publications

Is the proximal adductor canal block a better choice than the distal adductor canal block for primary total knee arthroplasty?

Is the proximal adductor canal block a better choice than the distal adductor canal block for primary total knee arthroplasty?

Intravenous versus oral paracetamol for postoperative analgesia: A systematic review

Impact of a perioperative oral opioid substitution protocol during the nationwide intravenous opioid shortage: A single center, interrupted time series with segmented regression analysis

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