Paracetamol Plus Ibuprofen Significantly Reduces Morphine Consumption After Hip Arthroplasty

ObjectiveTo examine the analgesic efficacy and safety of ketamine after total knee or hip arthroplasty.DesignSystematic review and meta-analysis.Data sourcesPubMed, EMBASE and Cochrane Library from inception to 22 May 2019.Eligibility criteria for selecting studiesRandomised controlled trials comparing the efficacy and safety of ketamine with placebo for postoperative pain relief in patients undergoing total knee or hip arthroplasty.Data extraction and synthesisData (ie, pain intensity, morphine consumption, gastrointestinal and psychotic adverse effects) were extracted by two reviewers independently. The Cochrane Collaboration’s recommended tool was used to determine the methodological quality of included studies.ResultsA total of 10 studies were included. One of them was rated as low quality. Compared with placebo, intravenous ketamine was effective for pain relief during 0–8-hour (weighted mean difference (WMD) −1.21, 95% CI −1.45 to −0.98, p<0.001; three studies, 149 participants) but not during 8–24-hour postoperative periods, and effective for reduction of cumulative morphine consumption during both 0–24-hour (WMD −17.76, 95% CI −31.25 to −4.27, p=0.01; five studies, 366 participants) and 0–48-hour (WMD −21.79, 95% CI −25.46 to −18.11, p<0.001; four studies, 252 participants) postoperative periods, without increasing risks of gastrointestinal or psychotic adverse effects. The limited data available for intra-articular (WMD −0.49, 95% CI −0.70 to −0.29, p<0.001; two studies, 83 participants) and epidural (WMD −2.10, 95% CI −3.30 to −0.90, p<0.001; one study, 20 participants) ketamine pointed to a significant reduction in pain intensity during 8–24-hour postoperative period.ConclusionsIntravenous administration of ketamine is effective and safe for postoperative pain relief in patients undergoing total knee or hip arthroplasty. Nevertheless, the analgesic efficacy and safety of ketamine in such patients seem to vary by different administration routes and still warrant further studies to explore.

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Addition of dexamethasone to local infiltration analgesia in elective total hip arthroplasty: a double-blind, randomized control trial

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-100873 ◽

2019 ◽

Vol 44 (11) ◽

pp. 1003-1009 ◽

Cited By ~ 3

Author(s):

Kariem El-Boghdadly ◽

Anthony James Short ◽

Rajiv Gandhi ◽

Vincent W S Chan

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Functional Outcomes ◽

Postoperative Nausea And Vomiting ◽

Morphine Consumption ◽

Local Infiltration Analgesia ◽

Double Blind ◽

Local Infiltration ◽

Total Hip

Background and objectivesPain following total hip arthroplasty is significant, and effective analgesia is associated with an improvement in functional outcomes. Dexamethasone may facilitate the action of local anesthesia, but its role as an additive to a local infiltration analgesia (LIA) mixture in hip arthroplasty settings has not been investigated. We hypothesized that the addition of dexamethasone to local anesthetic infiltration improves analgesic outcomes following total hip arthroplasty.MethodsWe performed a double-blind, randomized control trial of 170 patients undergoing total hip arthroplasty. Patients were randomized to receive LIA mixed with either 2 mL of saline 0.9% or 2 mL of dexamethasone 4 mg/mL. The primary outcome was 24 hours oral morphine consumption. Secondary outcomes included short-term and long-term analgesic and functional outcomes and adverse events.Results85 patients were included in each arm. 24 hours morphine consumption was similar between saline and dexamethasone groups, with a median (IQR (range)) of 75 (45–105 (0–240)) and 62.5 (37.5–102.5 (0–210)) mg, respectively (p=0.145). However, patients receiving dexamethasone had significantly reduced opioid consumption for their total in-hospital stay, but not at any other time points examined. Functional outcomes were similar between groups. The incidence of postoperative nausea and vomiting was reduced in patients receiving dexamethasone.ConclusionsThe addition of 8 mg dexamethasone to LIA did not reduce 24 hours morphine consumption but was associated with limited improvement in short-term analgesic outcomes and a reduction in postoperative nausea and vomiting. Dexamethasone had no effect on functional outcomes or long-term analgesia.Trial registration numberNCT02760043

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Effect of Combination of Paracetamol (Acetaminophen) and Ibuprofen vs Either Alone on Patient-Controlled Morphine Consumption in the First 24 Hours After Total Hip Arthroplasty

JAMA ◽

10.1001/jama.2018.22039 ◽

2019 ◽

Vol 321 (6) ◽

pp. 562 ◽

Cited By ~ 27

Author(s):

Kasper Højgaard Thybo ◽

Daniel Hägi-Pedersen ◽

Jørgen Berg Dahl ◽

Jørn Wetterslev ◽

Mariam Nersesjan ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Morphine Consumption ◽

Total Hip

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Posterior Quadratus Lumborum Block in Total Hip Arthroplasty

Anesthesiology ◽

10.1097/aln.0000000000003745 ◽

2021 ◽

Author(s):

Sophia Margareta Brixel ◽

Philippe Biboulet ◽

Fabien Swisser ◽

Olivier Choquet ◽

Yassir Aarab ◽

...

Keyword(s):

Hip Arthroplasty ◽

Multimodal Analgesia ◽

Hospital Length ◽

Morphine Consumption ◽

Hospital Length Of Stay ◽

Postanesthesia Care Unit ◽

Median Difference ◽

Pain Scores ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum

Background Pain management is important for ensuring early mobilization after hip arthroplasty; however, the optimal components remain controversial. Recently, the quadratus lumborum block has been proposed as an analgesic option. The current study tested the hypothesis that the posterior quadratus lumborum block combined with multimodal analgesia decreases morphine consumption after hip arthroplasty. Methods This study was a prospective, randomized, double-blind, placebo-controlled trial. Before general anesthesia, 100 participating patients scheduled for elective total hip arthroplasty were randomly allocated to receive a 30-ml injection posterior to the quadratus lumborum muscle with either 0.33% ropivacaine (n = 50) or normal saline (n = 50). For all patients, multimodal analgesia included systematic administration of acetaminophen, ketoprofen, and a morphine intravenous patient-controlled analgesia. The primary outcome was total intravenous morphine consumption in the first 24 h. Secondary outcomes recorded intraoperative sufentanil consumption; morphine consumption in the postanesthesia care unit; pain scores at extubation and at 2, 6, 12, and 24 h; motor blockade; time to first standing and ambulation; hospital length of stay; and adverse events. Results There was no significant difference in the 24-h total morphine consumption (ropivacaine group, median [interquartile range], 13 [7 to 21] versus saline group, 16 [9 to 21] mg; median difference, −1.5; 95% CI, −5 to 2; P = 0.337). Pain scores were not different between the groups (β = −0.4; 95% CI, −0.9 to 0.2; P = 0.199). There was no statistical difference between the two groups in intraoperative sufentanil consumption, morphine consumption in the postanesthesia care unit, motor blockade, times to first standing (median difference, 0.83 h; 95% CI, −1.7 to 3.4; P = 0.690) and ambulation (median difference, −1.85 h; 95% CI, −4.5 to 0.8; P = 0.173), hospital length of stay, and adverse events. Conclusions After elective hip arthroplasty, neither morphine consumption nor pain scores were reduced by the addition of a posterior quadratus lumborum block to a multimodal analgesia regimen. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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