Multi-modal, pre-emptive analgesia decreases the length of hospital stay following total joint arthroplasty.

Abstract

Traditional treatment of pain following total joint arthroplasty involves postoperative oral narcotic medications and intravenous patient-controlled analgesia, both of which can result in significant postoperative morbidity. Multi-modal analgesia involving >or=2 classes of drugs acting on different receptor types may be as effective as single-narcotic/patient-controlled analgesia with fewer analgesic-related side effects. In addition, administering analgesia prior to surgery (pre-emptive) may reduce postoperative pain intensity. The current study was designed to compare the impact of multi-modal pre-emptive analgesia versus patient-controlled analgesia on postoperative nausea, rehabilitation participation, and length of stay following total joint arthroplasty. A retrospective chart review and comparison was performed for patients undergoing total joint arthroplasty who received either postoperatively patient-controlled analgesia or pre-emptive analgesia (scheduled postoperative oxycodone and a COX-2 inhibitor). Length of hospital stay for the pre-emptive group averaged 2.74 vs 3.28 days for patient-controlled analgesia patients. The patient-controlled analgesia group consumed significantly more intravenous morphine (17.7 mg vs 7.2) and experienced a three-fold increase in nausea. In addition, the patient-controlled analgesia group was twice as likely to miss therapy and nearly 2 times more likely to be discharged to an extended care facility. The use of pre-emptive oxycodone and a selective COX-2 inhibitor decreased postoperative narcotic requirements and increased participation in rehabilitation. In addition, patients receiving pre-emptive analgesics had a decreased hospital length of stay and reduced likelihood of discharge to a skilled nursing facility. These data support the continued study and use of pre-emptive multi-modal analgesia paradigms in this population.

• Authors: Todd J Duellman, Catherine Gaffigan, Joseph C Milbrandt, D Gordon Allan
• Journal: Orthopedics (Orthopedics) Vol. 32 Issue 3 Pg. 167 (Mar 2009) ISSN: 1938-2367 [Electronic] United States
• PMID: 19309064 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Analgesics, Opioid
• Cyclooxygenase 2 Inhibitors
• Oxycodone

Topics

• Administration, Oral
• Analgesia, Patient-Controlled (methods)
• Analgesics, Opioid (therapeutic use)
• Arthroplasty, Replacement, Hip
• Arthroplasty, Replacement, Knee
• Cyclooxygenase 2 Inhibitors (therapeutic use)
• Drug Administration Schedule
• Drug Therapy, Combination
• Female
• Humans
• Injections, Intravenous
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Oxycodone (therapeutic use)
• Pain, Postoperative (prevention & control)
• Retrospective Studies