Non-Opioid Analgesics for Postoperative Pain Management Following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.
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BACKGROUND: Hip and knee arthroplasty are a fundamental part of modern orthopaedic practice. These procedures often require extensive postoperative analgesia, including opiate painkillers that are frequently associated with adverse side effects and risk of abuse. This review, therefore, investigated how postoperative administration of nonopioid coanalgesics (e.g., parecoxib, pregabalin) can affect postoperative pain scores and opioid use. METHODS: A systematic search of OVID, Embase, Medline, and PubMed was conducted, and studies were filtered to trials of patients undergoing arthroplasty who received nonopioid analgesia. Several meta-analyses were conducted to investigate the effects of various medications and classes at multiple postoperative time points on pain scores and opioid use. Standardized mean differences were conducted for analyses involving more than one measure of pain. There were 28 analyses included in the final review. RESULTS: On average, nonsteroidal anti-inflammatory drugs (NSAIDs) and gabapentinoids reduced between 9.30 and 10.89 mg, respectively of intravenous morphine in a 24-hour period. Reductions were also observed at various time points for NSAIDs, gabapentinoids, parecoxib, and pregabalin. Nonopioid coanalgesia improved pain at rest for various time points, including NSAIDs at postoperative day (POD) 1 and PODs 3 and 5. Parecoxib and corticosteroids were protective at POD 3. Pain during movement was significantly reduced by NSAIDs at 6 hours, POD 1, 2, and 3, with parecoxib demonstrating similar benefits at POD 1 and POD 2 to 3. CONCLUSIONS: This review found that postoperative administration of nonopioid coanalgesia may alleviate the need for opioids and have modest protective effects on postoperative pain. The effects of these analgesics, however, may be clinically nonmeaningful for reducing pain. These results may further implicate a need to implement nonopioid coanalgesia in postoperative patient care. Future research may include an updated investigation of this research question as more medication granular research becomes available.
