Combined treatment (Norspan, Gabapentin and Oxynorm) was found superior in pain management after total knee arthroplasty

2017 ◽  
Vol 16 (1) ◽  
pp. 176-176
Author(s):  
M.B. Jensen ◽  
M.M. Andersen ◽  
B. Boesen ◽  
M.B. Jørgensen ◽  
O. Simonsen
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Pain Treatment ◽  
Combined Treatment ◽  
Consecutive Series ◽  
Superior Effect ◽  
Total Knee ◽  
Postoperative Pain Treatment

Abstract Background Gabapentin (GAB) has recently been introduced for postoperative pain treatment in orthopedic surgery. As persistent postoperative pain is still a major problem in total knee arthroplasty (TKA), studies on the effect and side effects of Gabapentin in addition to the commonly used morphine (MOR), Oxynorm (OXY) and Norspan (NOR) are highly warranted. In the present study, four relevant treatment algorithms, gabapentin and morphine (GAB/MOR), gabapentin and Oxynorm (GAB/OXY), Oxynorm (OXY) and Gabapentin, Oxynorm and Norspan (GAB/OXY/NOR) were examined. Patients and methods A total of 241 patients were followed systematically during one month following TKA in four consecutive series: 60 patients were treated with GAB/MOR, 62 patients with GAB/OXY, 59 patients with OXY, and 60 patients with GAB/OXY/MOR. On the day before surgery and on postoperative day 1, 14, and 30, pain during rest, pain during walking and side effects (constipation, dizziness, and nausea) were reported (VAS). Results After 30 days, pain greatly decreased in all groups, with a superior effect of GAB/OXY/NOR for pain during rest and only slightly more side effects at day 1. Conclusions In management of postoperative pain following TKA, data indicated that GAB/OXY/NOR was superior, compared to GAB/MOR, GAB/OXY, and OXY.

Tapentadol vs oxycodone for postoperative pain treatment the first 7 days after total knee arthroplasty

Pain ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Torbjørn Rian ◽  
Eirik Skogvoll ◽  
Janne Hofstad ◽  
Lise Høvik ◽  
Siri B. Winther ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Pain Treatment ◽  
Total Knee ◽  
Postoperative Pain Treatment

scholarly journals Postoperative pain treatment after total knee arthroplasty: A systematic review

PLoS ONE ◽  
2017 ◽  
Vol 12 (3) ◽  
pp. e0173107 ◽  
Author(s):  
Anders Peder Højer Karlsen ◽  
Mik Wetterslev ◽  
Signe Elisa Hansen ◽  
Morten Sejer Hansen ◽  
Ole Mathiesen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Pain Treatment ◽  
Total Knee ◽  
Postoperative Pain Treatment

Analgesic Effect of Perioperative Escitalopram in High Pain Catastrophizing Patients after Total Knee Arthroplasty

2015 ◽  
Vol 122 (4) ◽  
pp. 884-894 ◽  
Author(s):  
Troels H. Lunn ◽  
Vibe G. Frokjaer ◽  
Torben B. Hansen ◽  
Per W. Kristensen ◽  
Thomas Lind ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Placebo Group ◽  
Side Effects ◽  
Knee Arthroplasty ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Pain Treatment ◽  
Pain Catastrophizing ◽  
Selective Serotonin ◽  
Total Knee

Abstract Background: Sufficient pain treatment remains a challenge after total knee arthroplasty (TKA), especially in high pain catastrophizing patients. Serotonergic signaling may be involved in pain processing, but the effect of selective serotonin reuptake inhibitors on well-defined postoperative pain has not previously been investigated. The authors hypothesized that perioperative escitalopram would reduce pain after TKA in high pain catastrophizing patients. Methods: A total of 120 pain catastrophizing patients (selected using the pain catastrophizing scale as preoperative screening tool) scheduled for TKA were randomized in a double-blind manner to either 10 mg escitalopram or placebo daily from preanesthesia to postoperative day 6 in addition to a standardized analgesic regime. The primary outcome was pain upon ambulation 24 h after surgery. Secondary outcomes were overall pain during well-defined mobilizations and at rest from 2 to 48 h and from days 2 to 6, morphine equivalents, anxiety, depression, and side effects. Results: Pain upon ambulation (mean [95% CI]) 24 h after surgery in the escitalopram versus placebo group was 58 (53 to 64) versus 64 (58 to 69), the mean difference being −5 (−13 to 3), P = 0.20. Overall pain upon ambulation and at rest from days 2 to 6 was lower in the escitalopram versus placebo group, as was depression score at day 6 (all P ≤ 0.01 in analyses uncorrected for multiple tests). Side effects were nonsignificant except for reduced tendency to sweat and prolonged sleep in the escitalopram group. No other between-group differences were observed. Conclusions: Escitalopram did not reduce pain upon ambulation 24 h after TKA in high pain catastrophizing patients. Future studies on optimal timing, dose, and duration of selective serotonin reuptake inhibitor treatment might be warranted.

scholarly journals Side-Effect Profiles And Efficacy Of Low Dose Intrathecal Morphine Combine With Periarticular Injection In Elective Primary Unilateral Total Knee Arthroplasty

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0009
Author(s):  
Chompunoot Pathonsamit ◽  
Pruk Chaiyakit ◽  
Ittiwat Onklin
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Side Effect ◽  
Pain Control ◽  
Intrathecal Morphine ◽  
Postoperative Pain Control ◽  
Periarticular Injection ◽  
Total Knee

Background: Total knee arthroplasty (TKA) is concerned as a severe postoperative pain procedure. Intrathecal morphine provides good analgesia but has many side effects such as nausea, vomiting, pruritus and respiratory depression. Appropriate postoperative pain control strategy with lower side effect is still challenging. We combined periarticular injection(PI) as a multimodal analgesia with intrathecal morphine in order to decrease intrathecal morphine dosage and lower side effects. Objective: To determine side-effect profiles and efficacy of 0.1 mg and 0.2 mg intrathecal morphine combine with PI in primary unilateral TKA. Material and method: In this prospective, double-blinded, randomized controlled trial. Patients undergoing TKA were recruited from April 2018 to April 2019. All patients were randomized into 3 groups. M 0 (n=32), M 1 (n=36)and M 2 (n=34) represent no intrathecal morphine, 0.1 mg and 0.2 mg intrathecal morphine respectively. All Group received same regimen of PI as a multimodal analgesia and same postoperative pain control protocol. Results: Patients in group M 2 had more nausea or vomiting side effects compared to group M 1 in early postoperative 4 hours(77.1% and 51.4%) with statistical significant(p<0.05) and also required 2 antiemetic drug to relieve symptoms (4.7% and 2.3%) with statistical significant ( p<0.05). No difference in postoperative pain score, rescue analgesic drug consumption ,pruritic score, sedation score, respiratory depression and orthopedic outcomes such as straight leg rising time and maximum active knee flexion between M 1 and M 2 groups. Conclusion: Lower intrathecal morphine dosage (0.1 mg) combine with periarticular injection in primary unilateral total knee arthroplasty provide similar postoperative pain control as standard intrathecal morphine dosage(0.2 mg) combine with periarticular injection with lower rates and severities of nausea and vomiting in first postoperative 4 hours.

Using pharmacogenetics to structure individual pain management protocols in total knee arthroplasty

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 73-78
Author(s):  
William G. Hamilton ◽  
Jeanine M. Gargiulo ◽  
Nancy L. Parks
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Genetic Variants ◽  
Control Group ◽  
Ongoing Research ◽  
Pain Scores ◽  
Pain Medications ◽  
Total Knee

Aims The purpose of this study was to use pharmacogenetics to determine the frequency of genetic variants in our total knee arthroplasty (TKA) patients that could affect postoperative pain medications. Pharmacogenetic testing evaluates patient DNA to determine if a drug is expected to have a normal clinical effect, heightened effect, or no effect at all on the patient. It also predicts whether patients are likely to experience side effects from medicine. We further sought to determine if changing the multimodal programme based on these results would improve pain control or reduce side effects. Methods In this pilot study, buccal samples were collected from 31 primary TKA patients. Pharmacogenetics testing examined genetic variants in genes OPRM1, CYP1A2, CYP2B6, CYP2C19, CYP3A4, CYP2C9, and CYP2D6. These genes affect the pharmacodynamics and pharmacokinetics of non-steroidal anti-inflammatory drugs and opioids. We examined the frequency of genetic variants to any of the medications we prescribed including celecoxib, hydrocodone, and tramadol. Patients were randomized to one of two groups: the control group received the standard postoperative pain regimen, and the study group received a customized regimen based on the pharmacogenetic results. For the first ten postoperative days, patients recorded pain scores, medication, and side effects. Results Genetic variants involving one or more medications in the multimodal pain protocol occurred in 13 of the 31 patients (42%). In total, eight patients (26%) had variants affecting more than one of the medications. For the 25 patients who recorded pain and medication logs, the mean pain levels and morphine equivalents (MEQs) consumed in the first ten days were higher in the control group than in the custom-guided group (p = 0.019 for pain and p = 0.655 for MEQ). Conclusion Overall, 42% of patients had a variant involving one of the pain medications prescribed in our perioperative pain program for TKA. Ongoing research will help determine if using these data to modify a patient’s medication will improve outcomes. Cite this article: Bone Joint J 2020;102-B(6 Supple A):73–78.

Impact of Intravenous Acetaminophen on Lengths of Stay and Discharge Status after Total Knee Arthroplasty

2018 ◽  
Vol 32 (01) ◽  
pp. 111-116 ◽  
Author(s):  
John Barrington ◽  
Ryan Hansen ◽  
Belinda Lovelace ◽  
Elaine Böing ◽  
Morad Chughtai ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Lengths Of Stay ◽  
Oral Group ◽  
Total Knee

AbstractPostoperative pain remains difficult to control after total knee arthroplasty (TKA). While various modalities have been used, they have been associated with several side effects. For example, opioids have many side effects including: sedation, dizziness, nausea, vomiting, constipation, respiratory depression, and can lead to dependency. Recently, intravenous (IV) acetaminophen has been introduced as a method to manage postoperative pain. Therefore, the purpose of this study was to compare the postoperative outcomes of TKA patients who received oral acetaminophen versus IV acetaminophen. Specifically, this study evaluated: (1) the hospital lengths of stay (LOS) and (2) discharge dispositions. The Premier Database was used to review patients who underwent TKA from 2012 to 2015. A total of 134,216 TKA patients received oral acetaminophen, whereas 56,475 TKA patients received IV acetaminophen postoperatively. LOS were calculated as the number of days from the date of hospital admission to the date of discharge, and the discharge disposition was categorized as to home or to a skilled nursing facility (SNF). Compared with the oral group, the IV acetaminophen group had a 0.14 days shorter LOS (95% confidence interval [CI], –0.15 to –0.13; p < 0.001) and 22% higher chance of being discharged home (odds ratio [OR] = 1.22; 95% CI, 1.19–1.25; p < 0.001). Also, compared with the oral group, the IV group had a 13% lower chance of being discharged to a SNF (OR = 0.87; 95% CI, 0.85–0.90; p < 0.001). This study demonstrated that TKA patients who received IV acetaminophen were associated with a significantly shorter hospital LOS as well as being discharged home and fewer patients had to go to SNF. This may lead to a reduction in the total cost of health care, while, at the same time, decreasing the resource use in patients who undergo TKA.

scholarly journals Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial

BMJ ◽  
2022 ◽  
pp. e067325
Author(s):  
Kasper Smidt Gasbjerg ◽  
Daniel Hägi-Pedersen ◽  
Troels Haxholdt Lunn ◽  
Christina Cleveland Laursen ◽  
Majken Holmqvist ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Primary Outcome ◽  
Pain Treatment ◽  
Statistical Significance ◽  
Minimal Important Difference ◽  
Morphine Consumption ◽  
Outcome Analysis ◽  
Total Knee

Abstract Objective To investigate the effects of one and two doses of intravenous dexamethasone in patients after total knee arthroplasty. Design Randomised, blinded, placebo controlled trial with follow-up at 90 days. Setting Five Danish hospitals, September 2018 to March 2020. Participants 485 adult participants undergoing total knee arthroplasty. Intervention A computer generated randomised sequence stratified for site was used to allocate participants to one of three groups: DX1 (dexamethasone (24 mg)+placebo); DX2 (dexamethasone (24 mg)+dexamethasone (24 mg)); or placebo (placebo+placebo). The intervention was given preoperatively and after 24 hours. Participants, investigators, and outcome assessors were blinded. All participants received paracetamol, ibuprofen, and local infiltration analgesia. Main outcome measures The primary outcome was total intravenous morphine consumption 0 to 48 hours postoperatively. Multiplicity adjusted threshold for statistical significance was P<0.017 and minimal important difference was 10 mg morphine. Secondary outcomes included postoperative pain. Results 485 participants were randomised: 161 to DX1, 162 to DX2, and 162 to placebo. Data from 472 participants (97.3%) were included in the primary outcome analysis. The median (interquartile range) morphine consumptions at 0-48 hours were: DX1 37.9 mg (20.7 to 56.7); DX2 35.0 mg (20.6 to 52.0); and placebo 43.0 mg (28.7 to 64.0). Hodges-Lehmann median differences between groups were: −2.7 mg (98.3% confidence interval −9.3 to 3.7), P=0.30 between DX1 and DX2; 7.8 mg (0.7 to 14.7), P=0.008 between DX1 and placebo; and 10.7 mg (4.0 to 17.3), P<0.001 between DX2 and placebo. Postoperative pain was reduced at 24 hours with one dose, and at 48 hours with two doses, of dexamethasone. Conclusion Two doses of dexamethasone reduced morphine consumption during 48 hours after total knee arthroplasty and reduced postoperative pain. Trial registration Clinicaltrials.gov NCT03506789 .

scholarly journals Efficacy of duloxetine compared with opioid for postoperative pain control following total knee arthroplasty

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253641
Author(s):  
Man Soo Kim ◽  
In Jun Koh ◽  
Keun Young Choi ◽  
Sung Cheol Yang ◽  
Yong In
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Pain Control ◽  
Readmission Rate ◽  
Postoperative Pain Control ◽  
Vas Score ◽  
Total Knee ◽  
One Year

Background The purpose of this study was to assess the efficacy of duloxetine as an alternative to opioid treatment for postoperative pain management following total knee arthroplasty (TKA). Methods Among 944 patients, 290 (30.7%) of patients received opioid or duloxetine for pain control for 6 weeks when the pain Visual Analogue Scale (VAS) score was greater than 4 out of 10 at the time of discharge. 121 patients in the Opioid group and 118 in the Duloxetine group were followed up for more than one year. Preoperative and postoperative patient reported outcome measures (pain VAS score, Western Ontario and McMaster Universities OA Index (WOMAC) score were compared. The rate of further drug prescription (opioid or duloxetine) after 6 weeks of first prescription, 30-day readmission rate, and side effects were also investigated. Results There was no significant difference in pain VAS score, WOMAC Pain and Function score, at each time point between before and after surgery (all p>0.05). Fifteen (9.8%) patients in the opioid group and six (4.4%) patients in the duloxetine group were prescribed additional medication after first 6 weeks, showing no significant (p>0.05) difference in proportion. The 30-day readmission rate and the incidence of side effects were also similar (all p>0.05). There was no difference in the incidence of side effects between the two groups (p>0.05). Conclusion Duloxetine and opioid did not show any difference in pain control, function, and side effects for up to one year after TKA. Although large-scale randomized controlled trials are still required to further confirm the side effects of duloxetine, it can be considered as an alternative to opioid for postoperative pain control following TKA.

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