Postoperative pain treatment after total knee arthroplasty: A systematic review

Abstract

IntroductionThe aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA).MethodsThis PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-based analgesic interventions after TKA. Bias was evaluated according to Cochrane methodology. Outcomes were opioid consumption (primary), pain scores at rest and during mobilization, adverse events, and length of stay. Interventions investigated in three or more trials were meta-analysed. Outcomes were evaluated using forest plots, Grading of Recommendations Assessment, Development and Evaluation (GRADE), L’Abbe Plots and trial sequential analysis.ResultsThe included 113 trials, investigating 37 different analgesic interventions, were characterized by unclear/high risk of bias, low assay sensitivity and considerable differences in pain assessment tools, basic analgesic regimens, and reporting of adverse events. In meta-analyses single and continuous femoral nerve block (FNB), intrathecal morphine, local infiltration analgesia, intraarticular injection of local anaesthetics, non-steroidal anti-inflammatory drugs, and gabapentinoids demonstrated significant analgesic effects. The 24-hour morphine-sparing effects ranged from 4.2 mg (CI: 1.3, 7.2; intraarticular local anaesthetics), to 16.6 mg (CI: 11.2, 22; single FNB). Pain relieving effects at rest at 6 hours ranged from 4 mm (CI: -10, 2; gabapentinoids), to 19 mm (CI: 8, 31; single FNB), and at 24 hours from 3 mm (CI: -2, 8; gabapentinoids), to 16 mm (CI: 8, 23; continuous FNB). GRADE-rated quality of evidence was generally low.ConclusionA low quality of evidence, small sample sizes and heterogeneity of trial designs prohibit designation of an optimal procedure-specific analgesic regimen after TKA.

A Randomized Controlled Study on the Safety and Effectiveness of Total Knee Arthroplasty Operated At Different Times under ERASA.

“…Changes in the degree of pain can be assessed by VAS. Karlsen et al conducted a meta-analysis of pain management after TKA and found that there is no best strategy for pain management after TKA, in the literature (22). In our study, the improvement of patients' postoperative pain in this study is similar to that of Wang et.…”

Antimicrobial effect of anesthetic‐eluting ultra‐high molecular weight polyethylene for post‐arthroplasty antibacterial prophylaxis

“…Typical doses of bupivacaine are in the range of 30–300 mg when delivered by intra‐articular injection or local infiltration . Our results showed that during the first three days the effective daily dose of bupivacaine being eluted from a bupivacaine‐loaded UHMWPE can be in this range.…”

“…Typical doses of bupivacaine are in the range of 30-300 mg when delivered by intra-articular injection or local infiltration. 25,41 Our results showed that during the first three days the effective daily dose of bupivacaine being eluted from a bupivacaine-loaded UHMWPE can be in this range. Although it is difficult to correlate in-vitro and in-vivo drug release kinetics, our results showed that it is possible to deliver clinically-relevant doses of bupivacaine for pain management from bupivacaine-loaded UHMWPE implants for at least 3 days.…”

A systematic review of the use of music interventions to improve outcomes for patients undergoing hip or knee surgery

“…Variability in measurement times across the seven studies examining pain outcomes led to the conclusion that patients undergoing hip or knee surgery experience postoperative pain at several time points during their hospitalization. Given the seven included studies on pain outcomes combined their music intervention with standard care, this difference in findings could be the result of heterogeneity of trial designs and lack of an optimal procedure‐specific analgesic regimen after hip or knee surgery (Karlsen et al., ). It is, therefore, reasonable to suggest that there is no consensus on when pain is mostly experienced, following hip or knee surgery, thus making it difficult to suggest a specific time point when music should be administered.…”