Perioperative Outcomes of Patients Who Were Not Candidates for Additional Nonsteroidal Anti-inflammatory Drugs in a Multimodal Pain Control Regimen for Total Knee Arthroplasty

Laoruengthana, Artit; Chaibhuddanugul, Nattharut; Rattanaprichavej, Piti; Malisorn, Saran; Tangsripong, Piroon; Pongpirul, Krit

doi:10.4055/cios20154

Cited by 4 publications

(3 citation statements)

References 26 publications

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Section: Discussionmentioning

confidence: 99%

“…NSAIDs have been integrated into routine clinical management in the joint replacement population because of their significant benefits, which include effective postoperative pain control [36] and a reduction in postoperative opioid consumption by up to 28% [18, 37]. Previous clinical evidence was limited to eight small randomised trials with a total of 1602 patients that did not detect any association between peri‐operative use of NSAIDs and the development of chronic pain and persistent opioid use [38].…”

Section: Discussionmentioning

confidence: 99%

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Association of peri‐operative prescription of non‐steroidal anti‐inflammatory drugs with continued prescription of opioids after total knee arthroplasty: a retrospective claims‐based cohort study

Hussain,

Brull,

Gilron

et al. 2024

Anaesthesia

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SummaryNon‐steroidal anti‐inflammatory drugs (NSAIDs) are one of the mainstays of multimodal pain management. While effective for acute pain control, recent pre‐clinical evidence has raised concerns regarding an association between NSAIDs and chronic pain and potential opioid use. Our objective was to explore the association between peri‐operative use of prescription NSAIDs and the need for continued opioid prescriptions lasting 90–180 days in previously opioid‐naïve patients undergoing total knee arthroplasty. A database of health claims in the USA was used to identify all opioid‐naïve adult patients who underwent primary knee arthroplasty between January 2010 and October 2021. We evaluated the magnitude of association between peri‐operative prescription NSAID claims and claims for opioids at 90 days postoperatively using multivariable logistic regression models. Secondary outcomes included: the magnitude of association between peri‐operative NSAID prescription and claims for opioids at 180 days postoperatively; and identifying other potential factors associated with opioid claims at 90 days postoperatively. After risk adjustment using multivariable logistic regression models in the 789,736‐patient cohort, the adjusted odds ratio (95%CI) for a continuous claim of opioids at 90 and 180 days postoperatively among patients with a peri‐operative NSAID prescription within 30 days was 1.32 (1.30–1.35), p < 0.001; and 1.12 (1.10–1.15), p < 0.001, respectively. This estimate of effect remained robust at 90 days after accounting for known potential confounders, including pre‐existing knee pain and acute postoperative pain severity. Similar analysis of other pain medications (e.g. paracetamol) did not detect such an association. This population‐based cohort study suggests that peri‐operative prescription NSAID use may be associated with continued opioid prescription claims at 90 and 180 days after knee arthroplasty, even after adjusting for other observed covariates for continuous opioid claims. These novel findings can inform clinical decision‐making for post‐surgical pain management, risk–benefit discussions with patients and future research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of peri‐operative prescription of non‐steroidal anti‐inflammatory drugs with continued prescription of opioids after total knee arthroplasty: a retrospective claims‐based cohort study

Hussain,

Brull,

Gilron

et al. 2024

Anaesthesia

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“…Particular restrictions on use are relevant for the elderly population, people taking anticoagulants, and people with a history of gastrointestinal bleeding and upper gastrointestinal ulcers, as NSAIDs are associated with frequent upper gastrointestinal bleeding [ 18 , 19 , 20 ]. In addition, NSAIDs should be used with caution in people with cardiovascular disease and have been found to tend to worsen congestive heart failure, increase blood pressure, and worsen adverse cardiovascular events, except acetylsalicylic acid, which is effective at low doses as a cardioprotectant [ 21 , 22 ]. Liver damage is a relatively rare case of side effects caused by NSAIDs; however, drugs from this group should not be used in the presence of cirrhosis of the liver due to the possibility of increased bleeding and the possibility of renal failure [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Fixed-Dose Combination of NSAIDs and Spasmolytic Agents in the Treatment of Different Types of Pain—A Practical Review

Janczura

Kobus-Moryson²,

Sip

et al. 2021

JCM

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This review presents the most common disease entities in which combinations of NSAIDs and spasmolytic drugs are used to reduce pain. The benefits of fixed-dose combination products (FDCs) are that they improve the response in people with insufficient monotherapy. Using the synergy or additive effect of drugs, it is possible to obtain a significant therapeutic effect and faster action with the use of smaller doses of individual drugs. In addition, one active ingredient may counteract adverse reactions from the other. Another essential aspect of the use of FDCs is the improvement of medical adherence due to the reduction in the pill burden on patients. It is also possible to develop a fixed-dosed combination product de novo to address a new therapeutic claim and be protected by patents so that the manufacturer can obtain exclusive rights to sell a particular FDC or a formulation thereof. The proposed fixed-dose combinations should always be based on valid therapeutic principles and consider the combined safety profile of all active substances included in the medicinal product. This review aims to identify which combinations of NSAIDs and spasmolytics have been developed and tested and which combinations are still under development.

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Effect of multiple analgesic pathways including local infiltration analgesia, peripheral nerve blocks, and intrathecal morphine for controlling pain after total knee arthroplasty

Toolyodpun

Laoruengthana

Kositanurit

et al. 2022

Eur J Orthop Surg Traumatol

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Perioperative Outcomes of Patients Who Were Not Candidates for Additional Nonsteroidal Anti-inflammatory Drugs in a Multimodal Pain Control Regimen for Total Knee Arthroplasty

Cited by 4 publications

References 26 publications

Association of peri‐operative prescription of non‐steroidal anti‐inflammatory drugs with continued prescription of opioids after total knee arthroplasty: a retrospective claims‐based cohort study

Association of peri‐operative prescription of non‐steroidal anti‐inflammatory drugs with continued prescription of opioids after total knee arthroplasty: a retrospective claims‐based cohort study

Fixed-Dose Combination of NSAIDs and Spasmolytic Agents in the Treatment of Different Types of Pain—A Practical Review

Effect of multiple analgesic pathways including local infiltration analgesia, peripheral nerve blocks, and intrathecal morphine for controlling pain after total knee arthroplasty

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