Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, The Sheridan Building, 125 S 9th Street, Suite 1000, Philadelphia, PA, 19107, USA.
Clin Orthop Relat Res. 2014 May;472(5):1489-95. doi: 10.1007/s11999-014-3555-4.
Elevated temperatures after total joint arthroplasty (TJA) are common and can be a source of anxiety both for the patient and the surgical team. Although such fevers rarely are caused by acute infection, many patients are subjected to extensive testing for elevated body temperature after surgery. We recently implemented a multimodal pain management regimen for TJA, which includes acetaminophen, pregabalin, and celecoxib or toradol, and because some of these medications have antipyrexic properties, it was speculated that this protocol might influence the frequency of postoperative pyrexia.
QUESTIONS/PURPOSES: The purpose of this study was to determine whether patients treated under this protocol were less likely to exhibit postoperative fever after primary TJA, compared with a historical control group, and whether they were less likely to receive postoperative testing as part of a fever workup.
We compared 1484 primary TJAs in which pain was controlled primarily with opioid-based relief from July 2004 to December 2006 with 2417 procedures from July 2009 to December 2011 during which time multimodal agents were used. The same three surgeons were responsible for care in both of these cohorts. Oral temperature readings in the first 5 postoperative days (POD) were drawn from a review of medical records, which also were evaluated for fever workup tests, including urinalysis, urine culture, chest radiograph, and blood culture. Fever was defined by the presence of a temperature measurement over 38.5 °C. Patients having preoperative fever or postoperative fever starting later than POD 5 were excluded. Before surgery, there were no differences between the groups' temperature measurements.
Fewer patients developed fever in the multimodal analgesia group than in the control group (5% versus 25%, p < 0.001). Furthermore, fewer patients underwent workup for fever in the multimodal analgesia cohort (1.8% of patients undergoing 155 individual tests) compared with the control cohort (9.8% of patients undergoing 247 individual tests; p < 0.001).
In addition to fewer adverse effects and better pain control, the multimodal analgesia protocol has the hidden benefit of dampening the temperature response to the surgical insult of TJA. The decreased rate of postoperative fever avoids unnecessary anxiety for the patient and the treating team and reduces healthcare resource use occasioned by working up postoperative fever.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
全关节置换术后（TJA）体温升高很常见，这不仅会使患者感到焦虑，也会使手术团队感到焦虑。尽管这种发热很少是由急性感染引起的，但许多患者在手术后会接受大量的发热检测。我们最近对 TJA 采用了多模式疼痛管理方案，其中包括对乙酰氨基酚、普瑞巴林、塞来昔布或托烷司琼，由于这些药物中的一些具有解热作用，因此有人推测该方案可能会影响术后发热的频率。
本研究的目的是确定与历史对照组相比，接受该方案治疗的患者在初次 TJA 后是否不太可能出现术后发热，以及他们是否不太可能接受术后发热检查作为发热检查的一部分。
我们比较了 2004 年 7 月至 2006 年 12 月期间 1484 例主要采用阿片类药物缓解疼痛的初次 TJA 与 2009 年 7 月至 2011 年 12 月期间 2417 例采用多模式药物治疗的手术。这两组均由同三位外科医生负责治疗。术后前 5 天（POD）的口腔温度读数取自病历回顾，病历中还评估了发热检查测试，包括尿液分析、尿液培养、胸部 X 光和血液培养。发热定义为体温超过 38.5°C。排除术前发热或术后发热晚于 POD 5 的患者。手术前，两组的体温测量值无差异。
多模式镇痛组发生发热的患者少于对照组（5%比 25%，p < 0.001）。此外，多模式镇痛组发热检查的患者（155 例患者进行了 155 项单独检查）少于对照组（247 例患者进行了 247 项单独检查；p < 0.001）。
除了不良反应更少、疼痛控制更好外，多模式镇痛方案还有一个隐藏的好处，即减轻 TJA 手术创伤引起的体温反应。术后发热发生率降低可避免患者和治疗团队不必要的焦虑，并减少因发热检查而引起的医疗资源使用。
III 级，治疗性研究。欲了解完整的证据分级描述，请参见作者指南。
