Multimodal Analgesia After Knee, Hip Arthroplasty and Perioperative Outcomes

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Of 1,318,165 patients who underwent total hip or knee arthroplasty between 2006 and 2016, 85.6% received multimodal analgesia.
Of 1,318,165 patients who underwent total hip or knee arthroplasty between 2006 and 2016, 85.6% received multimodal analgesia.

Multimodal analgesia after hip or knee arthroplasty may be associated with fewer complications and reduced opioid prescriptions and hospital length of stay, compared with unimodal analgesia, according to a study published in Anesthesiology.

Using a Premier Perspective database, researchers found that of 1,318,165 patients who underwent total hip or knee arthroplasty between 2006 and 2016, 85.6% received multimodal analgesia.

Compared with patients who received “opioids only” for pain management, those who received 2 or more modes of analgesia experienced 19% fewer respiratory and 26% fewer gastrointestinal complications, as well as an 18.5% decrease in opioid prescriptions and a 12.1% decrease in length of stay (P <.05 for all).

Analysis of total knee procedures showed similar patterns. Each added mode of analgesia was found to bring more positive effects in a stepwise manner.

Study limitations include possible data entry errors and a lack of clinical variables such as exact drug costs, preoperative opioid use, and neuraxial analgesia.

“While the optimal multimodal regimen is not yet known,” researchers said, “these findings encourage the promotion of perioperative analgesic protocols that combine multiple analgesic modalities,” concluded the study authors. They added, “Crucial follow-up studies are needed and should focus on identifying optimal multimodal regimens and patient subgroups most likely to benefit from each combination.”

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Reference

Memtsoudis S, Poeran J, Zubizarreta N, Cozowicz C, Mörwald E, Mariano E, Mazumdar M. Association of multimodal pain management strategies with perioperative outcomes and resource utilization: a population-based study [published online March 2, 2018]. Anesthesiology. doi: 10.1097/ALN.0000000000002132

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