Home Bratislava Medical Journal 2022 Bratislava Medical Journal Vol.123, No.6, p.449–454, 2022

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Published Monthly, in English
Founded: 1919
ISSN 0006-9248
(E)ISSN 1336-0345

Impact factor 1.2

 

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Bratislava Medical Journal Vol.123, No.6, p.449–454, 2022

Title: A multimodal opioid-sparing pain management following total knee replacement
Author: Marek LACKO, Martin MATUSKA, Martin FOLVARSKY, Ahmad GHARAIBEH, Antonia LACKOVA, Peter POLAN, Radoslav ZAMBORSKY

Abstract: OBJECTIVE: The purpose of this study is to compare the pain scores, opioid consumption, and range of motion of the operated knee after total knee replacement (TKR) in the 10-day follow-up period between a traditional opioid-containing pain management protocol and a multimodal opioid-sparing treatment protocol.
METHODS: This prospective, randomized, single-center study included 90 patients (24 men and 66 women; mean age 69.7±7.2 years) undergoing TKR for osteoarthritis between October 2019 and October 2020. Patients were randomized into 3 cohorts for comparison: traditional opioid-containing pain management protocol (n=30), multimodal opioid-sparing pain management protocol (n=30), and traditional opioid-containing pain management protocol with additional local infiltration analgesia (LIA). Changes in visual analog scale for pain (VAS), range of motion (ROM), and opioid consumption were compared between groups.
RESULTS: A lower mean postoperative VAS score was observed in the opioid-sparing cohort, which was statistically significant at all time points compared with the traditional cohorts. Mean total morphine consumption was significantly lower in the opioid-sparing cohort (2.7±5.8 MMEs) compared to the traditional (14.0±14.8 MMEs) and traditional with LIA cohorts (8.3±9.5 MMEs; p<0.05). The mean degree of flexion of the operated knee of patients was significantly greater in patients in the opioid-sparing group than in the other groups on the postoperative day 3 (opioid-sparing: 87.0±11.2°; traditional: 74.1±11.6°; traditional with LIA: 84.7±8.9°; p<0.05), as well as on day 10 (opioid-sparing: 99.3±10.8°; traditional: 87.3±12.4°; traditional with LIA: 92.5±9.7°; p<0.05). The rate of adverse events after TKR did not differ between the groups.
CONCLUSION: The results of this study suggest that a multimodal opioid-sparing pain protocol after TKR, which includes oral non-opioid medications and periarticular injection with bupivacaine, provides better pain relief and early functional gains with fewer rescue opioids compared to traditional opioid-based protocols (Tab. 4, Fig. 2, Ref. 22).

Keywords: total knee replacement, postoperative pain, pain management, opioid-sparing
Published online: 16-May-2022
Year: 2022, Volume: 123, Issue: 6 Page From: 449, Page To: 454
doi:10.4149/BLL_2022_070


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