PDF(Pubmed)
Abstract：
Adequate pain control after total knee arthroplasty (TKA) has been associated with improved patient mobility and satisfaction, and is a task that has historically relied on opioids. Multimodal analgesic regimens can be considered a therapeutic alternative for postoperative pain control to avoid opioid consumption and its adverse side effects. This study aimed to evaluate the use of a multimodal analgesia protocol based on nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen as an alternative to reduce opioid consumption in Hispanic patients undergoing primary TKA.
UNASSIGNED: An institutional review board-approved, randomized controlled trial evaluated postoperative pain control after TKA in a Hispanic population. The experimental opioid-sparing group received 30-mg ketorolac intravenously every 6 hours and 1-g acetaminophen orally every 6 hours as the patient requested. The experimental group had the option to use morphine and oxycodone combined with acetaminophen as a rescue therapy. The control group received opioids in the form of 0.1-mg/kg morphine intravenously every 6 hours and/or oxycodone combined with acetaminophen (2.5 and 325 mg), 2 tablets orally every 6 hours, as the patient requested. Sociodemographic, operative, and immediate postoperative data and pain intensity measurements according to the numerical rating scale (NRS) were compared between groups. Analgesic efficacy was assessed according to the NRS scores at 12, 24, and 48 hours postoperatively.
UNASSIGNED: Eighty-one Hispanic patients met inclusion criteria: 42 patients in the experimental group and 39 patients in the control group. None of the patients in the experimental group requested oxycodone combined with acetaminophen as a rescue therapy. Only 2 patients in the experimental group used a mean of 3.0 ± 1.4 mg of rescue morphine; in comparison, the control group consumed a mean of 28.0 ± 7.9 mg of morphine and 64.8 ± 26.0 mg of oxycodone per patient. A pain intensity decrease was observed in the experimental and control groups, with no postoperative evaluation differences at 12 hours (6.7 ± 2.9 compared with 5.9 ± 2.8; p = 0.209), 24 hours (6.2 ± 2.0 compared with 6.1 ± 2.2; p = 0.813), and 48 hours (4.7 ± 2.1 compared with 4.6 ± 1.7; p = 0.835).
UNASSIGNED: The use of a multimodal analgesic regimen based on intravenous ketorolac and oral acetaminophen was adequate in reducing postoperative pain and opioid consumption in Hispanic patients undergoing TKA.
UNASSIGNED: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
UNASSIGNED: An institutional review board-approved, randomized controlled trial evaluated postoperative pain control after TKA in a Hispanic population. The experimental opioid-sparing group received 30-mg ketorolac intravenously every 6 hours and 1-g acetaminophen orally every 6 hours as the patient requested. The experimental group had the option to use morphine and oxycodone combined with acetaminophen as a rescue therapy. The control group received opioids in the form of 0.1-mg/kg morphine intravenously every 6 hours and/or oxycodone combined with acetaminophen (2.5 and 325 mg), 2 tablets orally every 6 hours, as the patient requested. Sociodemographic, operative, and immediate postoperative data and pain intensity measurements according to the numerical rating scale (NRS) were compared between groups. Analgesic efficacy was assessed according to the NRS scores at 12, 24, and 48 hours postoperatively.
UNASSIGNED: Eighty-one Hispanic patients met inclusion criteria: 42 patients in the experimental group and 39 patients in the control group. None of the patients in the experimental group requested oxycodone combined with acetaminophen as a rescue therapy. Only 2 patients in the experimental group used a mean of 3.0 ± 1.4 mg of rescue morphine; in comparison, the control group consumed a mean of 28.0 ± 7.9 mg of morphine and 64.8 ± 26.0 mg of oxycodone per patient. A pain intensity decrease was observed in the experimental and control groups, with no postoperative evaluation differences at 12 hours (6.7 ± 2.9 compared with 5.9 ± 2.8; p = 0.209), 24 hours (6.2 ± 2.0 compared with 6.1 ± 2.2; p = 0.813), and 48 hours (4.7 ± 2.1 compared with 4.6 ± 1.7; p = 0.835).
UNASSIGNED: The use of a multimodal analgesic regimen based on intravenous ketorolac and oral acetaminophen was adequate in reducing postoperative pain and opioid consumption in Hispanic patients undergoing TKA.
UNASSIGNED: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
摘要：
全膝关节置换术（TKA）后适当的疼痛控制与改善患者的活动能力和满意度有关。这是一项历史上依赖阿片类药物的任务。多模式镇痛方案可以被认为是术后疼痛控制的治疗替代方案，以避免阿片类药物的消耗及其不良副作用。这项研究旨在评估基于非甾体抗炎药（NSAIDs）和对乙酰氨基酚的多模式镇痛方案的使用，以减少接受原发性TKA的西班牙裔患者的阿片类药物消耗。
■机构审查委员会批准，随机对照试验评估了西班牙裔人群TKA术后疼痛控制情况.实验性阿片类药物保留组每6小时静脉内接受30mg酮咯酸，每6小时口服1g对乙酰氨基酚。实验组可以选择使用吗啡和羟考酮联合对乙酰氨基酚作为抢救治疗。对照组每6小时静脉注射0.1mg/kg吗啡的阿片类药物和/或羟考酮联合对乙酰氨基酚（2.5和325mg），每6小时口服2片，正如病人所要求的。社会人口统计学，Operative,根据数字评定量表（NRS），比较两组之间的即时术后数据和疼痛强度测量值。根据术后12、24和48小时的NRS评分评估镇痛效果。
■81例西班牙裔患者符合纳入标准：实验组42例，对照组39例。实验组中没有患者要求羟考酮联合对乙酰氨基酚作为抢救治疗。实验组仅有2例患者平均使用3.0±1.4mg的救护吗啡;相比之下,对照组平均每名患者服用28.0±7.9mg吗啡和64.8±26.0mg羟考酮.在实验组和对照组中观察到疼痛强度降低,术后12小时无评价差异（6.7±2.9，5.9±2.8；p=0.209），24小时（6.2±2.0，6.1±2.2；p=0.813），和48小时（4.7±2.1，4.6±1.7；p=0.835）。
■使用基于静脉注射酮咯酸和口服对乙酰氨基酚的多模式镇痛方案足以减少接受TKA的西班牙裔患者的术后疼痛和阿片类药物消耗。
■治疗级别I.有关证据级别的完整描述，请参阅作者说明。
■机构审查委员会批准，随机对照试验评估了西班牙裔人群TKA术后疼痛控制情况.实验性阿片类药物保留组每6小时静脉内接受30mg酮咯酸，每6小时口服1g对乙酰氨基酚。实验组可以选择使用吗啡和羟考酮联合对乙酰氨基酚作为抢救治疗。对照组每6小时静脉注射0.1mg/kg吗啡的阿片类药物和/或羟考酮联合对乙酰氨基酚（2.5和325mg），每6小时口服2片，正如病人所要求的。社会人口统计学，Operative,根据数字评定量表（NRS），比较两组之间的即时术后数据和疼痛强度测量值。根据术后12、24和48小时的NRS评分评估镇痛效果。
■81例西班牙裔患者符合纳入标准：实验组42例，对照组39例。实验组中没有患者要求羟考酮联合对乙酰氨基酚作为抢救治疗。实验组仅有2例患者平均使用3.0±1.4mg的救护吗啡;相比之下,对照组平均每名患者服用28.0±7.9mg吗啡和64.8±26.0mg羟考酮.在实验组和对照组中观察到疼痛强度降低,术后12小时无评价差异（6.7±2.9，5.9±2.8；p=0.209），24小时（6.2±2.0，6.1±2.2；p=0.813），和48小时（4.7±2.1，4.6±1.7；p=0.835）。
■使用基于静脉注射酮咯酸和口服对乙酰氨基酚的多模式镇痛方案足以减少接受TKA的西班牙裔患者的术后疼痛和阿片类药物消耗。
■治疗级别I.有关证据级别的完整描述，请参阅作者说明。
