Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
J Arthroplasty. 2019 Jun;34(6):1155-1161. doi: 10.1016/j.arth.2019.02.033. Epub 2019 Feb 25.
Postoperative pain is a significant concern of patients before surgery. Multimodal pain management is an effective method of pain control after major orthopedic surgery. Acetaminophen is the most commonly used analgesic for the management of pain. It was hypothesized that 1000 mg of intravenous acetaminophen (IA) dosed every 6 hours would significantly reduce the postoperative pain score at rest and the opioid consumption volume in patients who would undergo total hip arthroplasty (THA) when compared to a control group.
A single-center, prospective, open-label randomized control study was conducted. A total of 97 patients undergoing unilateral primary THA were divided into 2 groups: the study group (IA) (n = 45) and the control group (n = 52). The study group received administered IA after surgery, while the control group received only a standard pain control. Both groups received a preoperative femoral nerve block and postoperative intravenous fentanyl citrate. The primary outcome was the evaluation of the pain score at rest 24 hours after surgery. The pain score was measured using the Numerical Rating Scale. The primary outcome of this study was analyzed using generalized estimating equation.
The IA group had a significant improvement in Numerical Rating Scale score at rest 24 hours after THA compared to the control group (-0.91, 95% confidence interval -1.56 to -0.26, P = .006), suggesting a positive effect of IA usage for pain relief. The total fentanyl citrate consumption after surgery for 24 hours was significantly lower in the IA group than those of the control group (52.07 ± 7.64 vs 57.83 ± 12.44 mg, P < .001).
Postoperative administration of IA significantly reduced the postoperative pain score and opioid consumption volume after primary THA. IA was useful as one role of multimodal pain management after THA.
Level 2.
术后疼痛是患者术前关注的重要问题。多模式疼痛管理是控制大骨科手术后疼痛的有效方法。对乙酰氨基酚是用于疼痛管理的最常用的镇痛药。研究假设，与对照组相比，在接受全髋关节置换术（THA）的患者中，每 6 小时静脉给予 1000mg 对乙酰氨基酚（IA）可显著降低静息时的术后疼痛评分和阿片类药物的用量。
进行了一项单中心、前瞻性、开放标签随机对照研究。共 97 例行单侧初次 THA 的患者分为 2 组：研究组（IA）（n=45）和对照组（n=52）。研究组术后给予 IA 治疗，对照组仅给予标准疼痛控制。两组均在术前接受股神经阻滞，术后给予静脉枸橼酸芬太尼。主要结局是评估术后 24 小时的静息疼痛评分。疼痛评分采用数字评分量表（NRS）进行评估。本研究的主要结局采用广义估计方程进行分析。
与对照组相比，IA 组在 THA 后 24 小时的 NRS 评分静息时有显著改善（-0.91，95%置信区间-1.56 至-0.26，P=0.006），表明 IA 对缓解疼痛有积极作用。IA 组术后 24 小时芬太尼枸橼酸盐的总消耗量明显低于对照组（52.07±7.64 比 57.83±12.44mg，P<0.001）。
术后给予 IA 可显著降低初次 THA 后患者的术后疼痛评分和阿片类药物的用量。IA 作为 THA 后多模式疼痛管理的一种方法是有用的。
2 级。
