Preventive analgesia in hip or knee arthroplasty: a systematic review

• Published in: Revista española de cirugía ortopédica y traumatología 2015-03, Vol.59 (2), p.73-90
• Main Authors: Díaz-Heredia, J, Loza, E, Cebreiro, I, Ruiz Iban, M Á
• Format: Article
• Language: eng ; spa
• ISSN: 1988-8856
• DOI: 10.1016/j.recot.2014.09.004

OBJECTIVETo analyze the efficacy and safety of preventive analgesia in patients undergoing hip or knee arthroplasty due to osteoarthritis.METHODSA systematic literature review was performed, using a defined a sensitive strategy on Medline, Embase and Cochrane Library up to May 2013. The inclusion criteria were: patients undergoing knee and/or hip arthroplasty, adults with moderate or severe pain (≥4 on a Visual Analog Scale). The intervention, the use (efficacy and safety) of pharmacological treatment (preventive) close to surgery was recorded. Oral, topical and skin patch drugs were included. Systematic reviews, meta-analysis, controlled trials and observational studies were selected.RESULTSA total of 36 articles, of moderate quality, were selected. The patients included were representative of those undergoing knee and/or hip arthroplasty in Spain. They had a mean age >50 years, higher number of women, and reporting moderate to severe pain (≥4 on a Visual Analog Scale). Possurgical pain was mainly evaluated with a Visual Analog Scale. A wide variation was found as regards the drugs used in the preventive protocols, including acetaminophen, classic NSAID, Cox-2, opioids, corticosteroids, antidepressants, analgesics for neuropathic pain, as well as others, such as magnesium, ketamine, nimodipine or clonidine. In general, all of them decreased post-surgical pain without severe adverse events.CONCLUSIONSThe use or one or more pre-surgical analgesics decreases the use of post-surgical drugs, at least for short term pain.