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Pain management

Large study supports use of multimodal pain management after joint replacement

Using data from more than 1.5 million patients who underwent joint replacement surgery, researchers found a stepwise increase in beneficial effects as the number of analgesic modes increased.

Coloured x-ray of a hip replacement

Source: Mehau Kulyk / Science Photo Library

A study found that hip arthroplasty patients who received more than two additional modes of pain management had 19% fewer respiratory complications and 26% fewer gastrointestinal complications compared with those on opioids only

Multimodal pain management is commonplace after joint replacement surgery. However, there is limited evidence to inform the optimal number of analgesics to be used.

In Anesthesiology (online, 2 March 2018), researchers used database records from 2006–2016 on 512,393 people who underwent total hip arthroplasty and 1,028,069 who underwent total knee arthroplasty and grouped them according to whether they were given opioids only or opioids plus one, two or more than two additional modes of analgesia[1]. Analgesic modes included opioids, peripheral nerve blocks, paracetamol, steroids, gabapentin/pregabalin, non-steroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors and ketamine.

Overall, 86% of patients received multimodal pain management. The researchers found a stepwise increase in beneficial effects as the number of analgesic modes increased. For example, hip arthroplasty patients who received more than two additional modes of analgesia had 19% fewer respiratory complications, 26% fewer gastrointestinal complications and a 19% decrease in opioid prescriptions compared with those receiving opioids only. Total knee arthroplasty analyses showed similar patterns.

The researchers said the results should encourage the use of multimodal perioperative analgesia for joint replacement surgery.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2018.20204706

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Supplementary images

  • Coloured x-ray of a hip replacement

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