Comparative Prospective Study of the Management of Preventive Analgesia in Patients Undergoing Primary Total Knee Arthroplasty
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Published:
Feb 11, 2021
Keywords:
Knee arthrosplasty, pain, preemptive analgesia
Main Article Content
Abstract
Background and Objective: Preventive analgesia is one that is administered hours or days before a total knee arthroplasty in order to reduce postoperative pain. The objective of this study was to compare and analyze the clinical efficiency of the use of preventive analgesia in patients undergoing total knee replacement.
Methods: Sixty-six patients, divided into two groups of 33 patients, were evaluated prospectively and comparatively between November 2018 and March 2019. Group A received preoperative analgesia with a combination of etoricoxib, tramadol, and paracetamol, orally, 2 hours before surgery. Control group B did not receive anything. The postoperative pain of the patients was evaluated according to their own records on a visual analog scale at 12, 24, 48, 72 hours and one week after surgery.
Results: A significant difference was observed at 24 hours between both groups, pain was significantly less for group A (p = 0.001), at 48 hours the difference was statistically lower than at 24 hours (p = 0.016). It was also observed that the control group required a greater number of rescues, although the difference was only significant at 24 hours (p = 0.047).
Conclusion: The combination of etoricoxib, tramadol and paracetamol is effective, safe, costeffective and easy to administer, with a low rate of adverse effects; which represents an adequate scheme for the management of preventive analgesia.Level of Evidence: IIb
Methods: Sixty-six patients, divided into two groups of 33 patients, were evaluated prospectively and comparatively between November 2018 and March 2019. Group A received preoperative analgesia with a combination of etoricoxib, tramadol, and paracetamol, orally, 2 hours before surgery. Control group B did not receive anything. The postoperative pain of the patients was evaluated according to their own records on a visual analog scale at 12, 24, 48, 72 hours and one week after surgery.
Results: A significant difference was observed at 24 hours between both groups, pain was significantly less for group A (p = 0.001), at 48 hours the difference was statistically lower than at 24 hours (p = 0.016). It was also observed that the control group required a greater number of rescues, although the difference was only significant at 24 hours (p = 0.047).
Conclusion: The combination of etoricoxib, tramadol and paracetamol is effective, safe, costeffective and easy to administer, with a low rate of adverse effects; which represents an adequate scheme for the management of preventive analgesia.Level of Evidence: IIb
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How to Cite
Lopreite, F. A., Iglesias, S., Veloz Serrano, D., Montero Vinces, A., & del Sel, H. (2021). Comparative Prospective Study of the Management of Preventive Analgesia in Patients Undergoing Primary Total Knee Arthroplasty. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(1), 31-38. https://doi.org/10.15417/issn.1852-7434.2021.86.1.1125
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Clinical Research
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References
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knee-replacement operations. Results of use for analgesia and for preemptive blockade. J Bone Joint Surg Am
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3. Browne C, Copp S, Reden L, Pulido P, Colwell C. Bupivacaine bolus injection versus placebo for pain management following total knee arthroplasty. J Arthroplasty 2004;19(3):377-80. https://doi.org/10.1016/j.arth.2003.10.012
4. Fowler SJ, Symons J, Sabato S, Myles PS. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: A systematic review and meta-analysis of randomized trials. Br J Anaesth 2008;100(2):154-64.
https://doi.org/10.1093/bja/aem373
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https://doi.org/10.1097/00001503-200208000-00005.9
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recovery from surgery: A systematic review of randomized controlled trials. Drugs 2010;70(9):1149-63.
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10. Dorr LD, Chao L. The emotional state of the patient after total hip and knee arthroplasty. Clin Orthop Relat
Res 2007;463:7-12. PMID: 17960669
11. Ong CKS, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative
pain management: A meta-analysis. Anesth Analg 2005;100(3):757-73. https://doi.org/10.1213/01.ANE.0000144428.98767.0E
12. Alexander R, El-Moalem HE, Gan TJ. Comparison of the morphine-sparing effects of diclofenac sodium and
ketorolac tromethamine after major orthopedic surgery. J Clin Anesth 2002;14(3):187-92. https://doi.org/10.1016/
s0952-8180(01)00382-8
13. Renner B, Walter G, Strauss J, Fromm MF, Zacher J, Brune K. Preoperative administration of etoricoxib in patients undergoing hip replacement causes inhibition of inflammatory mediators and pain relief. Eur J Pain 2012;16(6):838-48. https://doi.org/10.1002/j.1532-2149.2011.00062.x
14. Hendolin H, Nuutinen L, Kokki H, Tuomisto L. Does morphine premedication influence the pain and consumption of postoperative analgesics after total knee arthroplasty? Acta Anaesthesiol Scand 1996;40(1):81-5.
https://doi.org/10.1111/j.1399-6576.1996.tb04391.x
15. Skinner HB, Shintani EY. Results of a multimodal analgesic trial involving patients with total hip or total knee
arthroplasty. Am J Orthop (Belle Mead NJ) 2004;33(2):85-92; discussion 92.18. PMID: 15005598
16. Shahraki AD, Feizi A, Jabalameli M, Nouri S. The effect of intravenous dexamethasone on post-cesarean section pain and vital signs: A double-blind randomized clinical trial. J Res Pharm Pract 2013;2(3):99-104.
https://doi.org/10.4103/2279-042X.12237019
17. Buvanendran A, Kroin JS, Della Valle CJ, Kari M, Moric M, Tuman KJ. Perioperative oral pregabalin
reduces chronic pain after total knee arthroplasty: A prospective, randomized, controlled trial. Anesth Analg
2010;110(1):199-207. https://doi.org/10.1213/ANE.0b013e3181c4273a
18. Beaupre LA, Johnston DBC, Dieleman S, Tsui B. Impact of a preemptive multimodal analgesia plus femoral nerve blockade protocol on rehabilitation, hospital length of stay, and postoperative analgesia after primary total knee arthroplasty: A controlled clinical pilot study. Sci World J 2012: 273821. https://doi.org/10.1100/2012/273821
19. Eggers KA, Jenkins BJ, Power I. Effect of oral and i.v. tenoxicam in postoperative pain after total knee replacement. Br J Anaesth 1999;83(6):876-881. https://doi.org/10.1093/bja/83.6.876
20. Conselho Editorial CE. Editorial. Bol Goiano Geogr [Internet]. 2011;30(2). Disponible en:
http://revistas.ufg.br/index.php/bgg/article/view/13785
21. Rasmussen ML, Mathiesen O, Dierking G, Christensen BV, Hilsted KL, Larsen TK, et al. Multimodal analgesia
with gabapentin, ketamine and dexamethasone in combination with paracetamol and ketorolac after hip arthroplasty: A preliminary study. Eur J Anaesthesiol 2010;27(4):324-30. https://doi.org/10.1097/EJA.0b013e328331c71d
22. Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol 2009;22(5):588-93. https://doi.org/10.1097/ACO.0b013e328330373a
23. Ruiz Ibán MA, Maculé F, Torner P, Gil Garay E, Oteo-Álvaro A, López Millán JM, et al. Consenso SECOTGEDOS
sobre el control del dolor prequirúrgico en artrosis de rodilla y cadera. Rev Esp Cir Ortop Traumatol 2015;59(3):186-99. https://doi.org/10.1016/j.recot.2014.09.005
24. Liu D, Graham D, Gillies K, Gillies RM. Effects of tourniquet use on quadriceps function and pain in total knee
arthroplasty. Knee Surg Relat Res 2014;26(4):207-13. https://doi.org/10.5792/ksrr.2014.26.4.207
25. Kim TK, Bamne AB, Sim JA, Park JH, Na YG. Is lower tourniquet pressure during total knee arthroplasty effective? A prospective randomized controlled trial. BMC Musculoskelet Disord 2019;20(1):1-9. https://doi.org/10.1186/s12891-019-2636-7
de la artroplastia total de cadera y rodilla: Estudio multicéntrico en Cataluña. Rev Esp Cir Ortop Traumatol 2013;57(4):254-62. https://doi.org/10.1016/j.recot.2013.04.002
2. Badner NH, Bourne RB, Rorabeck CH, MacDonald SJ, Doyle JA. Intra-articular injection of bupivacaine in
knee-replacement operations. Results of use for analgesia and for preemptive blockade. J Bone Joint Surg Am
1996;78(5):734-8. https://doi.org/10.2106/00004623-199605000-00013
3. Browne C, Copp S, Reden L, Pulido P, Colwell C. Bupivacaine bolus injection versus placebo for pain management following total knee arthroplasty. J Arthroplasty 2004;19(3):377-80. https://doi.org/10.1016/j.arth.2003.10.012
4. Fowler SJ, Symons J, Sabato S, Myles PS. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: A systematic review and meta-analysis of randomized trials. Br J Anaesth 2008;100(2):154-64.
https://doi.org/10.1093/bja/aem373
5. Díaz-Heredia J, Loza E, Cebreiro I, Ruiz Iban M. Analgesia preventiva en artroplastia de cadera o rodilla: Una
revisión sistemática. Rev Esp Cir Ortop Traumatol 2015;59(2):73-90. https://doi.org/10.1016/j.recot.2014.09.004
6. Katz J, McCartney CJL. Current status of pre-emptive analgesia. Curr Opin Anaesthesiol 2002;15(4):435-41.
https://doi.org/10.1097/00001503-200208000-00005.9
7. McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative analgesia and
recovery from surgery: A systematic review of randomized controlled trials. Drugs 2010;70(9):1149-63.
https://doi.org/10.2165/10898560-000000000-00000
8. Gottschalk A, Raja SN. Severing the link between acute and chronic pain: The anesthesiologist’s role in preventive medicine. Anesthesiology 2004;101(5):1063-5. https://doi.org/10.1097/00000542-200411000-00004
9. Andersen LØ, Gaarn-Larsen L, Kristensen BB, Husted H, Otte KS, Kehlet H. Subacute pain and function after fasttrack hip and knee arthroplasty. Anaesthesia 2009;64(5):508-13. https://doi.org/10.1111/j.1365-2044.2008.05831.x
10. Dorr LD, Chao L. The emotional state of the patient after total hip and knee arthroplasty. Clin Orthop Relat
Res 2007;463:7-12. PMID: 17960669
11. Ong CKS, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative
pain management: A meta-analysis. Anesth Analg 2005;100(3):757-73. https://doi.org/10.1213/01.ANE.0000144428.98767.0E
12. Alexander R, El-Moalem HE, Gan TJ. Comparison of the morphine-sparing effects of diclofenac sodium and
ketorolac tromethamine after major orthopedic surgery. J Clin Anesth 2002;14(3):187-92. https://doi.org/10.1016/
s0952-8180(01)00382-8
13. Renner B, Walter G, Strauss J, Fromm MF, Zacher J, Brune K. Preoperative administration of etoricoxib in patients undergoing hip replacement causes inhibition of inflammatory mediators and pain relief. Eur J Pain 2012;16(6):838-48. https://doi.org/10.1002/j.1532-2149.2011.00062.x
14. Hendolin H, Nuutinen L, Kokki H, Tuomisto L. Does morphine premedication influence the pain and consumption of postoperative analgesics after total knee arthroplasty? Acta Anaesthesiol Scand 1996;40(1):81-5.
https://doi.org/10.1111/j.1399-6576.1996.tb04391.x
15. Skinner HB, Shintani EY. Results of a multimodal analgesic trial involving patients with total hip or total knee
arthroplasty. Am J Orthop (Belle Mead NJ) 2004;33(2):85-92; discussion 92.18. PMID: 15005598
16. Shahraki AD, Feizi A, Jabalameli M, Nouri S. The effect of intravenous dexamethasone on post-cesarean section pain and vital signs: A double-blind randomized clinical trial. J Res Pharm Pract 2013;2(3):99-104.
https://doi.org/10.4103/2279-042X.12237019
17. Buvanendran A, Kroin JS, Della Valle CJ, Kari M, Moric M, Tuman KJ. Perioperative oral pregabalin
reduces chronic pain after total knee arthroplasty: A prospective, randomized, controlled trial. Anesth Analg
2010;110(1):199-207. https://doi.org/10.1213/ANE.0b013e3181c4273a
18. Beaupre LA, Johnston DBC, Dieleman S, Tsui B. Impact of a preemptive multimodal analgesia plus femoral nerve blockade protocol on rehabilitation, hospital length of stay, and postoperative analgesia after primary total knee arthroplasty: A controlled clinical pilot study. Sci World J 2012: 273821. https://doi.org/10.1100/2012/273821
19. Eggers KA, Jenkins BJ, Power I. Effect of oral and i.v. tenoxicam in postoperative pain after total knee replacement. Br J Anaesth 1999;83(6):876-881. https://doi.org/10.1093/bja/83.6.876
20. Conselho Editorial CE. Editorial. Bol Goiano Geogr [Internet]. 2011;30(2). Disponible en:
http://revistas.ufg.br/index.php/bgg/article/view/13785
21. Rasmussen ML, Mathiesen O, Dierking G, Christensen BV, Hilsted KL, Larsen TK, et al. Multimodal analgesia
with gabapentin, ketamine and dexamethasone in combination with paracetamol and ketorolac after hip arthroplasty: A preliminary study. Eur J Anaesthesiol 2010;27(4):324-30. https://doi.org/10.1097/EJA.0b013e328331c71d
22. Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol 2009;22(5):588-93. https://doi.org/10.1097/ACO.0b013e328330373a
23. Ruiz Ibán MA, Maculé F, Torner P, Gil Garay E, Oteo-Álvaro A, López Millán JM, et al. Consenso SECOTGEDOS
sobre el control del dolor prequirúrgico en artrosis de rodilla y cadera. Rev Esp Cir Ortop Traumatol 2015;59(3):186-99. https://doi.org/10.1016/j.recot.2014.09.005
24. Liu D, Graham D, Gillies K, Gillies RM. Effects of tourniquet use on quadriceps function and pain in total knee
arthroplasty. Knee Surg Relat Res 2014;26(4):207-13. https://doi.org/10.5792/ksrr.2014.26.4.207
25. Kim TK, Bamne AB, Sim JA, Park JH, Na YG. Is lower tourniquet pressure during total knee arthroplasty effective? A prospective randomized controlled trial. BMC Musculoskelet Disord 2019;20(1):1-9. https://doi.org/10.1186/s12891-019-2636-7