The efficacy of pre-emptive analgesia on pain management in total knee arthroplasty: a mini-review

Xu, Jie; Li, Huan; Zheng, Chong; Wang, Bin; Shen, Pengfei; Xie, Z.; Qu, Yimin

doi:10.1186/s42836-019-0011-7

Cited by 15 publications

(8 citation statements)

References 44 publications

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“…Multimodal analgesia incorporates the use of analgesic drugs with different mechanisms of action to enhance postoperative analgesia [4]. Preemptive multimodal analgesia is an important part of multimodal analgesia [5], wherein multimodal analgesia is initiated before the painful stimulus with the goals of preventing central sensitization and ampli cation of pain during surgery [6]. In the last two decades, preoperative preemptive multimodal analgesia was widely adopted in centers performing total joint arthroplasty [7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of acetaminophen on preemptive multimodal analgesia in total knee arthroplasty: a prospective, double-blind, randomized placebo-controlled trial

Wang

et al. 2022

Preprint

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BackgroundPreemptive multimodal analgesia is a commonly used method to control pain following total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of preemptive acetaminophen for pain management in patients who underwent TKA.MethodsIn this prospective, double-blind, randomized placebo-controlled trial, 80 patients were randomized to the acetaminophen or control group. Patients in the acetaminophen group received celecoxib 400mg, pregabalin 150mg, and acetaminophen 325mg 2 hours before TKA. Patients in the control group received celecoxib, pregabalin, and placebo. Primary outcome was postoperative consumption of morphine hydrochloride used for rescue analgesia. Secondary outcomes included the time to the first rescue analgesia, postoperative pain as assessed by visual analogue scale (VAS), functional recovery as assessed by range of knee motion and ambulation distance, the time to hospital discharge, and complication rates.ResultsThere was no significant difference between the control group and the acetaminophen group in postoperative 0–24 h morphine consumption (average 11.3 mg vs. 12.3 mg, p = 0.445) and total morphine consumption (average 17.3 mg vs. 19.3 mg, p = 0.242). There was no significant difference in the time to the first rescue analgesia, postoperative VAS pain scores at any time points, postoperative functional recovery of knee, and the time to hospital discharge. The two groups had a similar occurrence of postoperative complications.ConclusionsThe addition of acetaminophen to preoperative preemptive multimodal analgesia could not reduce postoperative morphine consumption or improve pain relief. Orthopedic surgeons should reconsider routine use of preemptive acetaminophen in TKA.Trial registration: The study was prospectively registered on Chinese Clinical Trial Registry (identification number: ChiCTR2100052732) on 04/11/2021. http://www.chictr.org.cn/edit.aspx?pid=136730&htm=4

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Section: Discussionmentioning

confidence: 99%

Efficacy of acetaminophen on preemptive multimodal analgesia in total knee arthroplasty: a prospective, double-blind, randomized placebo-controlled trial

Wang

et al. 2022

Preprint

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“…Multimodal analgesia combines many analgesics with distinct mechanisms of action for enhancing postoperative analgesia 7 . Preemptive multimodal analgesia is an important part of multimodal analgesia, 8 in which multimodal analgesia is started prior to pain induction with the goals of preventing central sensitization and pain enhancement during surgery 9 . In the past two decades, preoperative preemptive multimodal analgesia has been broadly utilized in the setting of total joint arthroplasty 10–15 …”

Section: Introductionmentioning

confidence: 99%

Efficacy of Adding Acetaminophen to Preemptive Multimodal Analgesia in Total Knee Arthroplasty: A Double‐blinded Randomized Study

Wang

et al. 2023

Orthopaedic Surgery

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ObjectivePreemptive multimodal analgesia is a frequently utilized method for controlling pain after total knee arthroplasty (TKA). So far, no studies have specifically examined the efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA. The current work aimed to assess the efficacy of adding acetaminophen to preemptive multimodal analgesia for clinical pain management after TKA.MethodsThis was a double‐blinded randomized study including 80 cases randomized to the acetaminophen and control groups, respectively. The acetaminophen group was administered celecoxib at 400 mg, pregabalin at 150 mg, and acetaminophen at 300 mg 2 h before TKA. Control patients were administered celecoxib, pregabalin, and placebo. The primary outcome was postsurgical use of morphine hydrochloride for rescue analgesia. Secondary outcomes included the time to the initial rescue analgesia, postsurgical pain as determined by a visual analogue scale (VAS), functional recovery as reflected by the range of knee motion and ambulation distance, hospitalization duration, and complication rates. Continuous data with normal and skewed distributions were compared by the Student's t test and the Mann–Whitney U test, respectively. Categorical variables were compared by the Pearson's chi‐squared test.ResultsThe control and acetaminophen groups were comparable in postoperative 0–24 h morphine consumption (11.3 ± 6.5 mg vs 12.3 ± 7.7 mg, P = 0.445) and total morphine consumption (17.3 ± 10.1 mg vs 19.3 ± 9.4 mg, P = 0.242). Additionally, time to the initial rescue analgesia, postoperative VAS score at any time point, postoperative functional recovery of the knee, and hospitalization duration were similar in both groups. Both groups also had similar occurrence rates of postoperative complications.ConclusionsIn this study, adding acetaminophen to preoperative preemptive multimodal analgesia did not decrease postoperative morphine use or ameliorate pain relief. The efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA need to be further explored in future studies.

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“…Preemptive administration of analgesic medication is considered to be more effective in controlling postoperative pain than medication given after the onset of a painful stimulus [ 1 ]. Previous studies with preemptive analgesia show evidence of reduced postoperative opioid requirement [ 2 ]. Multimodal analgesia combines analgesic medications from different classes and employs analgesic techniques that target various mechanisms of pain [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Preemptive Multimodal Analgesia Regimen on Post-operative Epidural Demand Boluses in Lower Limb Orthopaedic Surgeries

George¹,

Kiran²,

Ravi³

2023

Cureus

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IntroductionExcruciating pain is associated with lower limb orthopaedic surgeries involving femoral shaft fractures. Postoperative pain management is still ineffective in low-resource settings where the use of epidural and opioid-free analgesia is impractical. Literature is scarce with respect to the effect of a preemptive multimodal analgesia regimen on the requirement of postoperative epidural demand boluses. Hence, the present study aimed to evaluate the effect of pre-emptive multimodal analgesia in reducing the requirement of epidural demand boluses postoperatively, and to find out the time required to receive the first epidural bolus. Material and methodsThis double-blinded randomized control study included 48 subjects. Patients aged 18-60 years with lower limb fractures requiring surgery under combined spinal-epidural anesthesia were included. Patients were divided into two groups through random allocation. Group A: Preemptive multimodal group received intravenous paracetamol 1 g, IV diclofenac 75 mg diluted in 100ml NS, IV tramadol 50 mg diluted in 100ml NS and tab pregabalin 75 mg orally, 30 mins before surgery. Group B: Placebo group received 3 pints of 100ml NS IV and tab ranitidine 150 mg, 30 mins before surgery. Intraoperatively, combined spinal-epidural anaesthesia was administered taking all the aseptic precautions. Visual analogue scale (VAS) was recorded immediately on shifting to a postoperative room, and then at 1, 4, 8, 12, and 24 hr for both groups. Epidural boluses (10 ml of 0.125% bupivacaine with 2 μg/ml of fentanyl) were given whenever the patient's visual analogue scale was more than 4. The time at which the first epidural bolus was required by the patient was recorded. The total number of epidural boluses given over 24 hours based on VAS was recorded for both, the preemptive and placebo groups. If the patient still complained of pain, IV diclofenac 75 mg was given if the VAS was more than 4, while IV diclofenac 75 mg along with IV tramadol 50 mg was given if the VAS was more than 6. Patient satisfaction with anesthesia care, in general, was assessed 24 hrs postoperatively. ResultsA total of 48 subjects were included in the study. During the immediate-postoperative period, and at 8, 12 and 24 hr, the median VAS was significantly low in group A as compared to group B. A significant increase in the demand for epidural bolus immediate-postoperatively was observed in group B (70.83%) compared to group A (4.17%) (p-value of <0.001). At 8 hr, 12hr, and 24hr, patients in group A found a significantly less need for epidural boluses compared to Group B. The mean total number of epidural boluses taken in group A was significantly less compared to group B (1.79 ± 0.41 VS 3.33 ± 0.48, p-Value <0.001). In group A, all patients reported no requirement for diclofenac and tramadol. In group B, 8.33% required diclofenac 75 mg, while the remaining 91.66% had no requirement for diclofenac and tramadol. The difference in patient satisfaction with anaesthesia care in general between the two study groups was f...

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The efficacy of pre-emptive analgesia on pain management in total knee arthroplasty: a mini-review

Cited by 15 publications

References 44 publications

Efficacy of acetaminophen on preemptive multimodal analgesia in total knee arthroplasty: a prospective, double-blind, randomized placebo-controlled trial

Efficacy of acetaminophen on preemptive multimodal analgesia in total knee arthroplasty: a prospective, double-blind, randomized placebo-controlled trial

Efficacy of Adding Acetaminophen to Preemptive Multimodal Analgesia in Total Knee Arthroplasty: A Double‐blinded Randomized Study

Effect of Preemptive Multimodal Analgesia Regimen on Post-operative Epidural Demand Boluses in Lower Limb Orthopaedic Surgeries

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