Regional and Multimodal Analgesia to Reduce Opioid Use after Total Joint Arthroplasty: A Narrative Review

Soffin, Ellen M.; Wu, Christopher L.

doi:10.1007/s11420-018-9652-2

Cited by 53 publications

(37 citation statements)

References 118 publications

(159 reference statements)

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“…Careful pain management is necessary after TKA and THA to achieve early postoperative mobilization while ensuring patient comfort throughout. [ 4 ] Moreover, effective pain control can quicken the recovery time and reduce the length of hospital stay. [ 5 , 6 ]…”

Section: Introductionmentioning

confidence: 99%

Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty

Qiao

2020

Medicine

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Background: The purpose of this meta-analysis was to comprehensively collect randomized controlled trials (RCTs) to assess the clinical efficacy of intrathecal morphine (ITM) versus local infiltration analgesia (LIA) in the treatment of total knee and hip arthroplasty patients. Methods: Relevant studies were identified from the Embase, PubMed, Cochrane Library, Web of Science, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases. We also reviewed the references of all identified articles to identify additional studies. For each study, we assessed the risk ratio (RR), weighted mean difference (WMD), and corresponding 95% confidence interval (95% CI) to synthesize outcomes. Meta-analysis was performed with Stata 12.0 software. Results: We included 13 studies with 942 patients for meta-analysis. LIA significantly decreased the pain value with rest or mobilization until 72 hours ( P < .05). LIA significantly decreased cumulative morphine consumption by 13.52 mg. Moreover, the length of hospital stay was lower in the LIA group than in the ITM analgesia group. Finally, LIA significantly reduced morphine-related complications (nausea and vomiting, pruritus, and respiration depression). Conclusions: LIA was an effective approach for relieving postoperative pain and reducing postoperative consumption of morphine compared with ITM in total knee and hip arthroplasty patients.

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Section: Introductionmentioning

confidence: 99%

Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty

Qiao

2020

Medicine

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“…Application of pain catheters: Most surgeons opted for “no application” of pain catheters after TKA in patients with high RTS expectations or no influence. There are various types of pain catheters available including intraarticular, continuous femoral nerve analgesia, epidural, and local infiltration analgesia (LIA) [ 75 , 76 , 77 , 78 , 79 , 80 , 81 ]. The rationale behind using pain catheters or application of a multimodal pain management is to promote early postoperative pain relief to allow quick recovery and rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for Patients with High Return to Sports Expectations after TKA Remain Controversial

Vu-Han

Gwinner

Perka

et al. 2020

JCM

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(1) Background: Improved surgical techniques and implants in total knee arthroplasty (TKA) have led to broader indications for surgical interventions of osteoarthritis of the knee. There is a growing young and active patient subgroup with high return to sports (RTS) expectations after TKA. The current lack of evidence regarding RTS capacity in this patient cohort, requires the consolidation of experts’ opinions and experiences to address the special needs among these patients. The aim of this study was to assess current expert opinions in regard to preoperative patient assessment, surgical technique and decision-making and patient counseling for these patients. (2) Methods: We performed a survey among surgeons specialized in arthroplasty with a questionnaire designed to assess current recommendations, surgical techniques, and implant preferences as well as patient counseling in patients with high expectations for RTS after TKA. (3) Results: The majority of surgeons are in favor of return to low-impact sports after TKA within 3 to 6 months. Some even recommend return to high-impact sports. Despite improvement of surgical techniques and implants, we observed no clear preference for a single surgical technique or implant specification in active patients. (4) Conclusions: Current evidence for sports-associated complications after TKA is scarce. Despite a growing array of surgical techniques and implants, the available literature is still controversial with no single surgical technique or TKA design distinguishing itself clearly from others. Surgeons’ recommendations are mostly based on their experience and training. Nonetheless, we observed growing faith in modern implants with some surgeons even recommending high-impact sports after TKA.

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“…Therefore, effective pain control plays an important role in early ambulation and results in better functional outcomes. [ 5 ] Moreover, effective pain control could increase overall patient satisfaction and decrease the economic costs owing to shorter hospital stays. [ 6 , 7 ]…”

Section: Introductionmentioning

confidence: 99%

Local infiltration vs epidural analgesia for postoperative pain control after total knee or hip arthroplasty

Zhang

et al. 2020

Medicine

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Background: Inconsistent results have been obtained regarding postoperative pain control using local infiltration and epidural analgesia for patients after total knee or hip arthroplasty (TKA and THA). We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and safety of local infiltration vs epidural analgesia for TKA and THA. Methods: Electronic searches were conducted on PubMed, EmBase, and the Cochrane library to identify eligible RCTs conducted up to February 2020. Weighted mean difference (WMD) and relative risk with 95% confidence interval (95%CI) were applied to calculate pooled effect estimates between local infiltration and epidural analgesia using the random-effects model. Results: Seven RCTs including a total of 412 TKA patients, and three RCTs including a total of 200 THA patients were selected for this meta-analysis. We noted that local infiltration was associated with lower visual analog scale (VAS) scores at rest after 48 hours (WMD: −1.31; 95%CI: −2.44 to −0.18; P = .024) and 72 hours (WMD: −0.95; 95%CI: −1.39 to −0.52; P < .001) for patients with TKA, while local infiltration significantly reduced VAS scores at rest after 12 hours for patients with THA (WMD: −1.00; 95%CI: −1.49 to −0.51; P < .001). Moreover, local infiltration was associated with lower VAS scores during movement after 48 hours in TKA patients (WMD: −1.08; 95%CI: −1.86 to −0.29; P = .007), while there were higher VAS scores during movement after 24 hours for patients with THA (WMD: 1.06; 95%CI: 0.67 to 1.45; P < .001). Furthermore, we noted that local infiltration was associated with higher flexion angles compared with epidural analgesia after 24 hours (WMD: 7.11; 95%CI: 2.30–11.93; P = .004), 48 hours (WMD: 6.69; 95%CI: 3.78 to 9.59; P < .001), and 72 hours (WMD: 5.19; 95%CI: 0.95–9.44; P = .016). There were no significant differences between local infiltration and epidural analgesia for the length of hospital stay, nausea, or wound infection. Conclusions: Local infiltration is superior to epidural analgesia for postoperative pain control after TKA, whereas for THA patients inconsistent results were obtained at various times.

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Regional and Multimodal Analgesia to Reduce Opioid Use after Total Joint Arthroplasty: A Narrative Review

Cited by 53 publications

References 118 publications

Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty

Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty

Recommendations for Patients with High Return to Sports Expectations after TKA Remain Controversial

Local infiltration vs epidural analgesia for postoperative pain control after total knee or hip arthroplasty

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