Recommendations for total hip arthroplasty pain management: what’s old, what’s new and what continues to be missing?

Abdallah, Faraj W.; McCartney, Colin J. L.

doi:10.1111/anae.15502

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…These regional techniques were recommended especially if patients had contraindications to basic analgesics or in patients with high expected postoperative pain. However, more lines of evidence are needed regarding regional techniques that provide adequate analgesia with early postoperative mobility, optimal functional recovery, and decreased postoperative morbidity under multimodal analgesic regimen [ 27 ]. The results of our study could aid in establishing multimodal analgesic protocols for THA patients.…”

Section: Discussionmentioning

confidence: 99%

Pericapsular Nerve Group (PENG) Block versus Supra-Inguinal Fascia Iliaca Compartment Block for Total Hip Arthroplasty: A Randomized Clinical Trial

Choi

Park

Lee

et al. 2022

JPM

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This study compared the effects of the pericapsular nerve group (PENG) block and supra-inguinal fascia iliaca compartment block (FICB) on postoperative analgesia and quadriceps strength following total hip arthroplasty under general anesthesia. A total of 58 patients were randomized to receive either PENG block (PENG group) or supra-inguinal FICB (FICB group) following anesthetic induction. The primary outcomes were the postoperative pain scores. Patients were randomized to receive either PENG block or supra-inguinal FICB following anesthetic induction. Pain scores at rest and with movement were assessed preoperatively, at the postanesthesia care unit (only at rest), and at 6, 24, 36, and 48 h postoperatively. Opioid consumption was also assessed for 48 h postoperatively. Quadriceps strength measurements were performed preoperatively, at 6, 24, and 36 h postoperatively. In total, 54 patients completed the study: 27 in the PENG group and 27 in the FICB group. Despite lower pain scores at rest in the PENG group at postoperative 6 and 24 h, there were no significant differences in the pain scores at rest and during movement between the two groups during postoperative 48 h in the linear mixed model analysis (p = 0.079 and p = 0.323, respectively). Cumulative opioid consumption up to postoperative 48 h was also similar in the two groups (p = 0.265). The changes in quadriceps strength measurements in the operative leg and the nonoperative leg were not significantly different between the groups (p = 0.513 and p = 0.523, respectively). The PENG block may have similar analgesic efficacy to the supra-inguinal FICB. No difference was detected in the quadriceps strength between the patients receiving these two blocks.

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Section: Discussionmentioning

confidence: 99%

Pericapsular Nerve Group (PENG) Block versus Supra-Inguinal Fascia Iliaca Compartment Block for Total Hip Arthroplasty: A Randomized Clinical Trial

Choi

Park

Lee

et al. 2022

JPM

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“…En este estudio, no hubo diferencias estadísticamente significativas en términos de dolor entre el primer tiempo (manejo ambulatorio) y el segundo tiempo quirúrgico (manejo intrahospitalario) en pacientes sometidos a cirugía de RTC bilateral, a pesar de que el promedio del puntaje en la EVA fue levemente menor en el primer tiempo que en el segundo (5,35 vs. 5,73 puntos). Si bien en todos los pacientes incluidos en este estudio se utilizó el esquema de manejo analgésico multimodal con infiltración periarticular y analgesia oral, siguiendo las guías y recomendaciones sobre manejo analgésico en el posoperatorio, 7,8 se encontró un rango elevado de dolor posoperatorio, el cual podría explicarse por el sesgo de memoria, dado que la encuesta en la que se recolectó información sobre esta variable fue realizada hasta 7 años después del procedimiento (enero de 2023).…”

Section: Discussionunclassified

“…El desarrollo de procedimientos quirúrgicos menos invasivos y de estrategias para prevenir la pérdida de sangre, así como un mejor control del dolor perioperatorio en pacientes ambulatorios en comparación con aquellos que reciben manejo intrahospitalario [6][7][8] han permitido mejorar los protocolos de rehabilitación, disminuyendo la frecuencia de posibles complicaciones inherentes a la hospitalización [9][10][11][12][13] y los costos para los sistemas de salud. 4,14 En este contexto, surge la necesidad de estudiar la satisfacción y el control del dolor en pacientes sometidos a RTC con manejo ambulatorio.…”

Section: Introductionunclassified

Niveles de dolor y satisfacción en pacientes sometidos a reemplazo total de cadera bilateral en dos tiempos quirúrgicos (manejo ambulatorio e intrahospitalario)

Ramírez-Guerrero,

Manrique-González,

Restrepo-Uribe

et al. 2023

Rev. colomb. ortop traumatol.

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Introducción. Con la mejora en las técnicas quirúrgicas de implantación de prótesis de cadera, los avances en analgesia y la estandarización de protocolos posoperatorios, junto con la rehabilitación temprana, se ha disminuido la estancia hospitalaria y se ha favorecido la realización de reemplazos totales de cadera (RTC) ambulatorios. Objetivo. Determinar los niveles de dolor y satisfacción posoperatorios en pacientes sometidos a cirugía de RTC bilateral en dos tiempos quirúrgicos (tiempo 1: manejo ambulatorio; tiempo 2: manejo intrahospitalario) y comparar de manera exploratoria dichos niveles entre los tiempos quirúrgicos. Metodología. Estudio observacional descriptivo realizado en 52 pacientes sometidos a RTC bilateral en dos tiempos quirúrgicos en dos hospitales de cuarto nivel de atención de Bogotá D.C. (Colombia) entre enero de 2013 y noviembre de 2022. El dolor posoperatorio fue evaluado con la escala visual análoga (EVA) y la satisfacción con el procedimiento, mediante la escala validada de satisfacción del paciente autodiligenciada (SAPS). Resultados. La mediana de edad fue 64,5 años y 65,38% fueron mujeres. El puntaje promedio en la EVA fue 5,35 y 5,73 en el primer y segundo tiempo, respectivamente (p=0,52). Además, la mediana del puntaje global en la SAPS en ambos tiempos fue 93,7 (p=0,91). Se observó una mayor frecuencia de reconsulta a urgencias (1,92% vs. 9,62%; p=0,02) y eventos adversos (0 vs. 1,92%; p=0,84) en el segundo tiempo quirúrgico. Conclusiones. La satisfacción con el procedimiento fue alta en ambos tiempos quirúrgicos y el nivel de dolor fue mayor en el segundo tiempo, sin que la diferencia fuera estadísticamente significativa.

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“…Total hip arthroplasty (THA) is the most performed elective orthopaedic surgery in developed countries [1,2]. THA may be associated with significant postoperative pain, which may adversely affect patient recovery and postoperative rehabilitation [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Effect of different low doses of intrathecal morphine (0.1 and 0.2 mg) on pain and vital functions in patients undergoing total hip arthroplasty: a randomised controlled study

et al. 2022

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Background Orthopaedic surgeries are among the most painful procedures. By adding low-dose morphine to intrathecal bupivacaine for spinal anaesthesia, the analgesic effect can be improved. The objeсtive of the study was tо compare the efficacy and safety of lоw-dоse (0.1 mg аnd 0.2 mg) intrаtheсаl mоrphine (ITM). Methods А prоspeсtive rаndоmised study was соnduсted at the Hоspitаl оf Trаumаtоlоgy аnd Оrthоpaediсs, Riga, Latvia (February 2020 tо May 2021) and enrolled 90 patients undergoing primary hip arthroplasty. All subjects were randomised intо three study grоups, using the online tool оn www.randomiser.org. Treatment groups were allocated to intrathecal morphine (0.1 mg and 0.2 mg) in addition to bupivacaine (15 to 18 mg). The primary outcome was postoperative pain intensity among the three study groups within 24 hours by NRS. The secondary outcomes: pain at rest 4 h, 7 h, 12 h, 24 h postoperatively, respiratory rate, SpО2, morphine соnsumptiоn, оxygen supply, opioid-related аdverse reасtiоns within 24 hours postoperatively. Dаtа were аnаlysed using R version 4.2.0, applying the Mann-Whitney test, Pearson’s chi-squared test, Fisher’s exact test, Friedman test, Wilcoxon test. Results The primary outcome in the control, ITM 0.1 mg, ITM 0.2 mg groups, respectively: 2.56, 0.87, 0.28 (p < 0.001). The secondary outcomes in the control, ITM 0.1 mg, ITM 0.2 mg group, respectively: pain scores 4h – 1.21, 0.48, 0.17 (p = 0.068); 7 h – 2.62, 1.00, 0.17 (p < 0.001); 12 h – 3.08, 0.65, 0.37 (p < 0.001); 24 h – 2.50, 1.20, 0.41 (p < 0.001); rescue medication requests (incidence, %): 77%, 16.7%, 13.3% (p < 0.001); mean respiratory rate (breath/min) – 15.2; 15.2 (p > 0.05); mean SpO2 (%): 96.7%; 95.7%; 96.07%. Significant adverse effects: pruritus in ITM 0.2 mg group (23% of subjects, p < 0.001). Conclusions Adult patients undergoing THA under spinal anaesthesia with bupivacaine and 0.2 mg morphine had superior analgesia to patients who received spinal analgesia with bupivacaine or bupivacaine and 0.1 mg morphine. Trial registration Study ID ISRCTN37212222; 20/04/2022 (registered retrospectively)

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Recommendations for total hip arthroplasty pain management: what’s old, what’s new and what continues to be missing?

Cited by 5 publications

References 16 publications

Pericapsular Nerve Group (PENG) Block versus Supra-Inguinal Fascia Iliaca Compartment Block for Total Hip Arthroplasty: A Randomized Clinical Trial

Pericapsular Nerve Group (PENG) Block versus Supra-Inguinal Fascia Iliaca Compartment Block for Total Hip Arthroplasty: A Randomized Clinical Trial

Niveles de dolor y satisfacción en pacientes sometidos a reemplazo total de cadera bilateral en dos tiempos quirúrgicos (manejo ambulatorio e intrahospitalario)

Effect of different low doses of intrathecal morphine (0.1 and 0.2 mg) on pain and vital functions in patients undergoing total hip arthroplasty: a randomised controlled study

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