Reducing the Pain: A Systematic Review of Postdischarge Analgesia Following Elective Orthopedic Surgery

Abstract

Opioids and cyclooxygenase-2 inhibitors are effective in providing analgesia in the extended postoperative period following orthopedic surgery with a minimal side-effect profile, while nonselective NSAIDs need to be treated with caution. Homeopathy is not an effective analgesic, while acupuncture has varied evidence and effectiveness. Treatment of postoperative fatigue may also improve analgesia control. This study provides orthopedic surgeons with a basis for evidence-based prescribing of postdischarge analgesia. However, further studies to validate these results against modern reporting standards are needed.

Nature’s wrath—The effect of weather on pain following orthopaedic trauma

“…High levels of preoperative pain and decreased functional status have been shown to increase the perception of pain after treatment [25,29,30]. Additionally, most patients in the postoperative period derive significant analgesia from pharmacologic pain relievers [28,31]. This can greatly affect patient reported pain depending on how often the patient is using pain medication and whether or not the patient is taking pain medication at the time of VAS survey administration.…”

“…Obviously, patients who live in consistently low barometric pressure environments would not be expected to have more pain following trauma surgery. This study was also limited by variance in pain scores due to factors unrelated to weather conditions, as pain and functional status are both highly confounded by a host of variables [25][26][27][28][29][30][31]. We were not able to account for patients with treatment complications or pre-existing pain conditions.…”

“…In the immediate post-operative period, there are many factors that affect patient pain besides weather [25][26][27][28][29][30][31]. Concomitant soft tissue injuries resulting from the initial trauma can be extremely painful and often require significant healing time [25,26].…”

Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes

“…This improved side effect profile makes COX-2 inhibitors a class to consider for mild to moderate postoperative pain. Several studies have demonstrated lower pain scores and decreased rescue analgesia consumption with the use of COX-2 inhibitors in knee and hip arthroplasty patients [31]. Whilst they are a convenient nonopioid option, COX-2 inhibitors are contraindicated in patients with compromised renal function and should be used with caution in patients with a history of coronary artery or cerebrovascular disease [12].…”

“…NSAID Roberts et al [31] Cochrane review Cyclooxygenase-2 inhibitors are effective in providing analgesia in the extended postoperative period following orthopedic surgery with a minimal side effect profile. Nonselective NSAID provide effective analgesia, with greater benefits observed with longer treatment duration.…”