The efficacy and safety of selective COX-2 inhibitors for postoperative pain management in patients after total knee/hip arthroplasty: a meta-analysis

Summary Objectives: The authors investigated the impact of computerized provider order entry (CPOE) on the delivery times of analgesia and subsequent patient outcomes. We hypothesized that patients would report less pain and use less pain medications compared with the previous paper-based system. Methods: Two groups of patients after a total hip (THA) or knee arthroplasty (TKA) were retrospectively compared: one comprising 106 patients when the paper-based ordering system was in effect (conventional group), and one comprising 96 patients after CPOE was installed (electronic group). All patients received a regional anaesthetic at surgery (combined spinal-epidural). TKA patients also received a single-injection femoral nerve block. After transfer to the postoperative anaesthesia care unit (PACU), a patient-controlled epidural analgesia (PCEA) infusion was initiated. The following data was collected from the PACU record: time to initiation of analgesia, visual analog scale (VAS) pain scores at initiation of analgesia and hourly for the first postoperative day (POD), volume of pain medication used, length of stay (LOS) in the PACU and the hospital. Results: The time to initiation of analgesia from arrival in the PACU was significantly lower in the electronic group compared to the conventional group (24.5 ± 28.3 minutes vs. 51.1 ± 26.2 minutes; mean ± SD, p < 0.001), as were VAS pain scores (0.82 ± 1.08 vs. 1.5 ± 1.52, p < 0.001) and the volume of PCEA needed to control pain (27.9 ± 20.2 ml vs. 34.8 ± 20.3 ml, p = 0.001) at 4 hours postoperatively. PACU LOS and hospital LOS did not significantly differ in the two groups. Conclusions: After implementation of CPOE, patients received their postoperative analgesia faster, had less pain, and required less medication. Citation: Urban M,Chiu T, Wolfe S, Magid S. Electronic Ordering System Improves Postoperative Pain Management after Total Knee or Hip Arthroplasty. Appl Clin Inform 2015;6: 591–599http://dx.doi.org/10.4338/ACI-2014-12-RA-0114

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Pericapsular nerve group (PENG) block for postoperative pain management in patients undergoing total hip arthroplasty surgery: a systematic review and meta-analysis

10.37766/inplasy2021.7.0092 ◽

2021 ◽

Author(s):

Shengshuang Ding ◽

Jie Zhang ◽

Xiaoyu Qin ◽

Weihua Huang ◽

Rongrong Duan ◽

...

Keyword(s):

Systematic Review ◽

Pain Management ◽

Postoperative Pain ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Postoperative Pain Management ◽

Total Hip ◽

Arthroplasty Surgery

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Analgesic efficacy and safety of ketamine after total knee or hip arthroplasty: a meta-analysis of randomised placebo-controlled studies

BMJ Open ◽

10.1136/bmjopen-2018-028337 ◽

2019 ◽

Vol 9 (9) ◽

pp. e028337 ◽

Cited By ~ 1

Author(s):

Bei Xu ◽

Yilun Wang ◽

Chao Zeng ◽

Jie Wei ◽

Jiatian Li ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Adverse Effects ◽

Pain Intensity ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Analgesic Efficacy ◽

Morphine Consumption ◽

Efficacy And Safety ◽

Total Knee

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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