More is better than less analgesic after total knee replacement in geriatric patient. Is it a myth?

Cery Tarise Hajali; Komang Agung Irianto; Kukuh Dwiputra Hernugrahanto

doi:10.15562/bmj.v12i2.4251

More is better than less analgesic after total knee replacement in geriatric patient. Is it a myth?

Cery Tarise Hajali ,

Komang Agung Irianto ,

Kukuh Dwiputra Hernugrahanto ,

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DOI: https://doi.org/10.15562/bmj.v12i2.4251 |
Published: 2023-06-19

Abstract

Purpose: This study aims to assess the effectiveness of mono pharmacy and polypharmacy on the post-TKR outcome, the speed of recovery, time to partial weight-bearing, VAS, and the side effects of single, double, and triple analgesia in elderly TKR patients.

Methods: This observational retrospective comparative study comparing the post-TKR surgical outcome and using mono pharmacy or polypharmacy analgesics was conducted in an Orthopaedic Hospital during 2012-2021. Patients who underwent TKR with a subarachnoid spinal block were diagnosed with osteoarthritis grade IV and treated with single/ unilateral TKR were included in this study. Data would be analyzed using either ANOVA or Kruskal Walis. Treatment of analgesia was given by the anesthesiologist, who determined the types and methods of administration.

Results: A total of 152 patients were included in this study. Most samples were females (N=106, 69.7%) aged 63.75 ± 6.31 years. There was no significant difference between analgetic use on LOS, time to PWB, and VAS on days 1, 3, and 5 (p > 0.05). A significant linear difference was found between nausea and gastric pain incidence with the amount of postoperative analgetic administration (p = 0.01).

Conclusion: The effectiveness of mono pharmacy and polypharmacy is similar regarding the speed of recovery, time to partial weight-bearing, VAS, and side effects of post-TKR patients.

References

Feng J, Novikov D, Anoushiravani A et al. Total knee arthroplasty: improving outcomes with a multidisciplinary approach. J Multidiscip Healthc 2018; 11: 63.
Liu SS, Buvanendran A, Rathmell JP et al Cross-Sectional Survey on Prevalence and Risk Factors for Persistent Postsurgical Pain 1 Year After Total Hip and Knee Replacement. Reg Anesth Pain Med 2012; 37: 415–22.
Pasero C, McCaffery M. Orthopaedic Postoperative Pain Management. J Perianesthesia Nurs 2007; 22: 160–74.
Li J wen, Ma Y shuo, Xiao L kun. Postoperative Pain Management in Total Knee Arthroplasty. Orthop Surg 2019; 11: 755–61.
Yang J, Bauer BA, Wahner-Roedler DL et al. The Modified WHO Analgesic Ladder: Is It Appropriate for Chronic Non-Cancer Pain? J Pain Res 2020; Volume 13: 411–
Chapman CR, Vierck CJ. The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms. J Pain 2017; 18: 359.e1-e38.
Bates C, Laciak R, Southwick A et al. Overprescription of postoperative narcotics: A look at postoperative pain medication delivery, consumption, and disposal in urological practice. J Urol 2011; 185: 551–5.
Gupta A, Abubaker H, Demas E et al. A randomized trial comparing the safety and efficacy of intravenous ibuprofen versus ibuprofen and acetaminophen in knee or hip arthroplasty. Pain Physician 2016; 19: 349–56.
Murata-Ooiwa M, Tsukada S, Wakui M. Intravenous acetaminophen in multimodal pain management for patients undergoing total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. J Arthroplasty 2017; 5403: 30419–29.
O’Neal JB, Freiberg AA, Yelle M et al. Intravenous vs oral acetaminophen as an adjunct to multimodal analgesia after total knee arthroplasty: a prospective, randomized, double-blind clinical trial. J Arthroplasty 2017; 5403: 30444–48.
Zhao S, Chen F, Feng A et al. Risk Factors and Prevention Strategies for Postoperative Opioid Abuse. Pain Res Manag 2019; 2019: 1–12.
Wunsch H, Wijeysundera DN, Passarella MA et al. Opioids prescribed after low-risk surgical procedures in the United States, 2004-2012. JAMA - J Am Med Assoc 2016; 315: 1654–57.
Berthelot JM, Darrieutort-Lafitte C, Le Goff B et al. Strong opioids for noncancer pain due to musculoskeletal diseases: Not more effective than acetaminophen or NSAIDs. Jt Bone Spine 2015; 82: 397–401.
Teng Y, Zhang Y, Li B. Intravenous versus oral acetaminophen as an adjunct for pain and recovery after total knee arthroplasty: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99: e23515.
Goel RK, Suri V, Suri A et al. Effect of bone marrow-derived mononuclear cells on nerve regeneration in the transection model of the rat sciatic nerve. J Clin Neurosci 2009; 16: 1211–17.
Hansen RN, Pham AT, Böing EA et al. Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen. Curr Med Res Opin 2017; 33: 943–48.
Rahma AI, Awalia A. Perioperative management of patient with late rheumatoid arthritis and post-bone tuberculosis with genu contracture undergoing tenotomy. Bali Med J. 2022;11(2):913–
Suandika M, Muti RT, Ru-Tang W, Haniyah S, Astuti D. Impact of Opioid-Free Anesthesia on Nausea, Vomiting and pain Treatment in Perioperative Period: A Review. Bali Med J. 2021;10(1 Special issue ICONURS):1408–14.
Rawung R, Juliandi T. The functional outcome in short-term follow up after Total Knee Replacement (TKR) in Kandou Hospital, Manado, Indonesia. Bali Med J. 2019;8(3):S803–6.

[1] Feng J, Novikov D, Anoushiravani A et al. Total knee arthroplasty: improving outcomes with a multidisciplinary approach. J Multidiscip Healthc 2018; 11: 63.

[2] Liu SS, Buvanendran A, Rathmell JP et al Cross-Sectional Survey on Prevalence and Risk Factors for Persistent Postsurgical Pain 1 Year After Total Hip and Knee Replacement. Reg Anesth Pain Med 2012; 37: 415–22.

[3] Pasero C, McCaffery M. Orthopaedic Postoperative Pain Management. J Perianesthesia Nurs 2007; 22: 160–74.

[4] Li J wen, Ma Y shuo, Xiao L kun. Postoperative Pain Management in Total Knee Arthroplasty. Orthop Surg 2019; 11: 755–61.

[5] Yang J, Bauer BA, Wahner-Roedler DL et al. The Modified WHO Analgesic Ladder: Is It Appropriate for Chronic Non-Cancer Pain? J Pain Res 2020; Volume 13: 411–

[6] Chapman CR, Vierck CJ. The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms. J Pain 2017; 18: 359.e1-e38.

[7] Bates C, Laciak R, Southwick A et al. Overprescription of postoperative narcotics: A look at postoperative pain medication delivery, consumption, and disposal in urological practice. J Urol 2011; 185: 551–5.

[8] Gupta A, Abubaker H, Demas E et al. A randomized trial comparing the safety and efficacy of intravenous ibuprofen versus ibuprofen and acetaminophen in knee or hip arthroplasty. Pain Physician 2016; 19: 349–56.

[9] Murata-Ooiwa M, Tsukada S, Wakui M. Intravenous acetaminophen in multimodal pain management for patients undergoing total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. J Arthroplasty 2017; 5403: 30419–29.

[10] O’Neal JB, Freiberg AA, Yelle M et al. Intravenous vs oral acetaminophen as an adjunct to multimodal analgesia after total knee arthroplasty: a prospective, randomized, double-blind clinical trial. J Arthroplasty 2017; 5403: 30444–48.

[11] Zhao S, Chen F, Feng A et al. Risk Factors and Prevention Strategies for Postoperative Opioid Abuse. Pain Res Manag 2019; 2019: 1–12.

[12] Wunsch H, Wijeysundera DN, Passarella MA et al. Opioids prescribed after low-risk surgical procedures in the United States, 2004-2012. JAMA - J Am Med Assoc 2016; 315: 1654–57.

[13] Berthelot JM, Darrieutort-Lafitte C, Le Goff B et al. Strong opioids for noncancer pain due to musculoskeletal diseases: Not more effective than acetaminophen or NSAIDs. Jt Bone Spine 2015; 82: 397–401.

[14] Teng Y, Zhang Y, Li B. Intravenous versus oral acetaminophen as an adjunct for pain and recovery after total knee arthroplasty: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99: e23515.

[15] Goel RK, Suri V, Suri A et al. Effect of bone marrow-derived mononuclear cells on nerve regeneration in the transection model of the rat sciatic nerve. J Clin Neurosci 2009; 16: 1211–17.

[16] Hansen RN, Pham AT, Böing EA et al. Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen. Curr Med Res Opin 2017; 33: 943–48.

[17] Rahma AI, Awalia A. Perioperative management of patient with late rheumatoid arthritis and post-bone tuberculosis with genu contracture undergoing tenotomy. Bali Med J. 2022;11(2):913–

[18] Suandika M, Muti RT, Ru-Tang W, Haniyah S, Astuti D. Impact of Opioid-Free Anesthesia on Nausea, Vomiting and pain Treatment in Perioperative Period: A Review. Bali Med J. 2021;10(1 Special issue ICONURS):1408–14.

[19] Rawung R, Juliandi T. The functional outcome in short-term follow up after Total Knee Replacement (TKR) in Kandou Hospital, Manado, Indonesia. Bali Med J. 2019;8(3):S803–6.

More is better than less analgesic after total knee replacement in geriatric patient. Is it a myth?

Abstract

References

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