Multimodal Analgesia and Education Reduced Post-Arthroplasty Pain, Opioid Consumption

A mature medicine presenting a total knee arthroplasty and x-ray to a female patient. This is a so called duohead prosthesis.
The provision of multimodal nonopioid analgesia was linked to reduced subacute pain after total knee and hip arthroplasty.

A systematic review found that interventions involving analgesic use education and multimodal nonopioid analgesics decreased pain intensity and opioid consumption follow total knee arthroplasty (TKA) and total hip arthroplasty (THA). These findings were published in Pain Medicine.

A collaborative group of investigators in Australia searched publication databases through April 2021 for randomized controlled trials of analgesic interventions among patients undergoing TKA or THA. A total of 4 studies met the inclusion criteria, 3 of which were 2-arm randomized trials, and 1 was a 3-arm parallel-group randomized trial.

In 1 study (n=235), patients who received multimodal nonopioid analgesia (1000 mg paracetamol every 8 hours, 200 mg gabapentin every 12 hours, and 15 mg daily meloxicam) plus 10 tablets each of oxycodone and tramadol reported reduced pain during the first 30 days after surgery (coefficient, -0.81; 95% CI, -1.33 to -0.29; P =.003) compared with patients who received only paracetamol and 60 tablets each of oxycodone and tramadol.

Similarly, patients who received the nonopioid analgesia plus 60 opioid tablets reported lower pain (coefficient, -0.61; 95% CI, -1.13 to -0.09; P =.021).

The multimodal nonopioid analgesia associated with reduced opioid consumption (coefficient range, -0.77 to -0.30; P £.04) and those who received 10 pills had lower consumption than those who received 60 (coefficient, -0.46; 95% CI, -0.76 to -0.17; P =.002).

The time to opioid discontinuation was shortest among the nonopioid plus 10 pill group (1.14 weeks; P <.001), followed by nonopioid plus 60 pill group (1.39 weeks; P =.001) and paracetamol plus 60 pill recipients (2.57 weeks).

In another study, patients (n=304) who received 30 5-mg oxycodone tablets were not found to have reduced opioid consumption compared with patients who were given 90 pills (P =.881) and more who received 30 tablets requested a prescription refill (26.7% vs 10.5%; P <.001).

An education intervention in 1 study gave either a personalized pain management application for a smart phone, personalized advice, physiotherapy exercise, and nonpharmacologic pain management or usual care among 71 patients. Overall, no significant effect on pain was observed, however, patients who used the smart phone application ³12 times reported a 4.1-times faster reduction in pain scores (P =.02). The intervention group overall consumed 23.2% fewer opioids (P =.02) and 14% more paracetamol (P <.01).

Another study included a home visit intervention from a multidisciplinary team or usual care among 50 patients. Those who received 2 home visits had significantly reduced pain scores (P <.001), greater range of motion (P =.001), reduced time to move independently (P =.005), and better functional scores (P =.037).

This systematic review was limited by not assessing publication bias overall and by not conducting a meta-analysis; however, it was not possible due to the heterogenous nature of the trials.

The findings of this review suggested that interventions involving multimodal nonopioid analgesics and patient education may decrease pain and opioid consumption following TKA or THA.


Liu S, Genel F, Harris IA, et al. Effectiveness of pharmacological-based interventions including education and prescribing strategies to reduce subacute pain following total hip or knee arthroplasty: A systematic review of randomised controlled trials. Pain Med. 2022;pnac052. doi:10.1093/pm/pnac052