Oral Multimodal Analgesia for Total Joint Arthroplasty

Golladay, Gregory J.; Balch, Karl; Dalury, David F.; Satpathy, Jibanananda; Jiranek, William A.

doi:10.1016/j.arth.2017.05.002

Cited by 84 publications

(65 citation statements)

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“…Improved pain management could possibly be achieved using opioids or peripheral nerve blocks as part of the standard analgesic regime, but adverse effects such as an increased risk of falls upon initiation of opioid use as well as sedation, delirium, nausea, and urinary retention have been reported (Golladay et al 2017, Seppala et al 2018. Also, peripheral nerve blocks have limited additional value alongside LIA (Gudmundsdottir and Franklin 2017).…”

Section: Discussionmentioning

confidence: 99%

Why are patients still in hospital after fast-track, unilateral unicompartmental knee arthroplasty

et al. 2020

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Background and purpose — Previous studies have investigated risk factors related to prolonged length of stay following total knee arthroplasty (TKA), but little is known about specific factors resulting in continued hospitalization within the 1st postoperative days after unicompartmental knee arthroplasty (UKA). We investigated what specific factors prevent patients from being discharged on the day of surgery (DOS) and the first postoperative day (POD-1) following primary UKA in a fast-track setting. Patients and methods — We prospectively collected data on 100 consecutive and unselected medial UKA patients operated from December 2017 to May 2019. All patients were operated in a standardized fast-track setup with functional discharge criteria continuously evaluated from DOS and until discharge. Results — Median length of stay for the entire cohort was 1 day. 22% and 78% of all patients were discharged on DOS and POD-1, respectively. Lack of mobilization and pain separately delayed discharge in respectively 78% and 24% of patients on DOS. The main reasons for lack of mobilization were motor blockade (37%) and logistical factors (26%). For patients placed 1st or 2nd on the operating list, we estimate that the same-day discharge rate would increase to 55% and 40% respectively, assuming that pain and mobilization were successfully managed. Interpretation — One-fifth of unselected UKA patients operated in a standardized fast-track setup were discharged on DOS. Pain and lack of mobilization were the major reasons for continued hospitalization within the initial postoperative 24–48 hours. Strategies aimed at decreasing length of stay after UKA should strive to improve analgesia and postoperative mobilization.

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Section: Discussionmentioning

confidence: 99%

Why are patients still in hospital after fast-track, unilateral unicompartmental knee arthroplasty

et al. 2020

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“…44 There are many reviews and large studies on multimodal analgesia using widely available and affordable options such as acetaminophen and NSAIDs. 45 Some studies have also demonstrated synergism when these are used together. 46,47 Furthermore, adjunctive options such as gabapentinoids have been demonstrated to be opioid sparing, in particular when a neuropathic pain component is involved.…”

Section: Recommendations and Summary Of Evidencementioning

confidence: 99%

Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery

Clarke

Manoo

Pearsall

et al. 2020

Canadian Journal of Pain

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This Consensus Statement provides recommendations on the prescription of pain medication at discharge from hospital for opioid-naïve adult patients who undergo elective surgery. It encourages health care providers (surgeons, anesthesiologists, nurses/nurse practitioners, pain teams, pharmacists, allied health professionals, and trainees) to (1) use nonopioid therapies and reduce the prescription of opioids so that fewer opioid pills are available for diversion and (2) educate patients and their families/caregivers about pain management options after surgery to optimize quality of care for postoperative pain. These recommendations apply to opioid-naïve adult patients who undergo elective surgery. This consensus statement is intended for use by health care providers involved in the management and care of surgical patients. A modified Delphi process was used to reach consensus on the recommendations. First, the authors conducted a scoping review of the literature to determine current best practices and existing guidelines. From the available literature and expertise of the authors, a draft list of recommendations was created. Second, the authors asked key stakeholders to review and provide feedback on several drafts of the document and attend an in-person consensus meeting. The modified Delphi stakeholder group included surgeons, anesthesiologists, residents, fellows, nurses, pharmacists, and patients. After multiple iterations, the document was deemed complete. The recommendations are not graded because they are mostly based on consensus rather than evidence. RÉSUMÉ Cette déclaration de consensus fait des recommandations pour la prescription d'analgésiques à la sortie de l'hôpital pour les patients adultes n'ayant jamais pris d'opiacés et qui subissent une intervention chirurgicale non urgente. Elle encourage les prestataires de soins de santé (chirurgiens, anesthésiologistes, infirmières et infirmiers, infirmières et infirmiers praticiens, équipes antidouleur, pharmaciens, professionnels de la santé et stagiaires) à (1) utiliser des traitements non opiacés et à réduire la prescription d'opiacés afin de réduire le nombre de pilules opiacées pouvant être détournées; et (2) à éduquer les patients, ainsi que leurs familles et soignants, sur les options de prise en charge de la douleur après l'opération afin d'optimiser la qualité des soins pour la douleur postopératoire. Ces recommandations s'appliquent aux patients adultes n'ayant jamais pris d'opioïdes et qui subissent une intervention chirurgicale non urgente. Cette déclaration de consensus est destinée à être utilisée par les prestataires de soins de santé impliqués dans la prise en charge des patients opérés et les soins qui leur sont apportés. Un processus Delphi modifié a été utilisé pour parvenir à un consensus sur les recommandations. Tout d'abord, les auteurs ont procédé à une de la portée de la littérature afin de déterminer les pratiques exemplaires actuelles et les lignes directrices existantes. À partir de la littérature disponible et de l'expertise des ...

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“…Необхідність контролю болю пов'язана з ранньою мобілізацією, зменшенням тривалості перебування в стаціонарі та післяопераційних ускладнень [6]. Сьогодні мультимодальну анальгезію вважають оптимальним методом для контролю болю та зменшення використання опіоїдів після ендопротезування кульшового та колінного суглобів [7,8].…”

Section: результати та їх обговоренняunclassified

Multimodal analgesia with anapiron, nonsteriod anti-inflammatory drugs, local infiltrative anesthesia, and pregabalin in case of primary total hip arthroplasty

Bondarenko¹,

Filipenko²,

Lyzogub³

et al. 2018

ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS

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Oral Multimodal Analgesia for Total Joint Arthroplasty

Cited by 84 publications

References 50 publications

Why are patients still in hospital after fast-track, unilateral unicompartmental knee arthroplasty

Why are patients still in hospital after fast-track, unilateral unicompartmental knee arthroplasty

Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery

Multimodal analgesia with anapiron, nonsteriod anti-inflammatory drugs, local infiltrative anesthesia, and pregabalin in case of primary total hip arthroplasty

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