Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY.
Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2019 Jul;34(7S):S215-S220. doi: 10.1016/j.arth.2019.02.030. Epub 2019 Mar 6.
Multimodal analgesia including acetaminophen is increasingly popular for analgesia after total hip arthroplasty (THA). Intravenous (IV) administration of acetaminophen has pharmacokinetic benefits, but unclear clinical advantages. The authors hypothesized that IV acetaminophen would reduce pain with activity, opioid usage, or opioid-related side effects, compared to oral acetaminophen.
In this double-blinded, randomized, controlled trial, 154 THA patients received either IV or oral acetaminophen as part of a comprehensive opioid-sparing multimodal analgesia strategy. Primary outcomes were pain with physical therapy on postoperative day (POD) 1, opioid side effects (POD 1), and cumulative opioid use.
There was no difference in opioid side effects, pain scores, or opioid use between the groups.
Patients in both groups had low pain scores, minimal opioid side effects, and limited opioid usage (corresponding to 6 doses of tramadol 100 mg over 3 days). This highlights multimodal analgesia as an effective method of pain control for THA.
包括对乙酰氨基酚在内的多模式镇痛在全髋关节置换术后（THA）的镇痛中越来越受欢迎。静脉（IV）给予对乙酰氨基酚具有药代动力学优势，但临床优势尚不清楚。作者假设与口服对乙酰氨基酚相比，IV 给予对乙酰氨基酚会减少活动时、使用阿片类药物时或与阿片类药物相关的副作用时的疼痛。
在这项双盲、随机、对照试验中，154 例接受 THA 的患者接受了 IV 或口服对乙酰氨基酚，作为一种包括阿片类药物在内的综合、节省阿片类药物的多模式镇痛策略的一部分。主要结局是术后第 1 天（POD1）物理治疗时的疼痛、阿片类药物副作用（POD1）和累积阿片类药物使用量。
两组在阿片类药物副作用、疼痛评分或阿片类药物使用量方面均无差异。
两组患者的疼痛评分均较低，阿片类药物副作用最小，阿片类药物使用量有限（相当于 3 天内使用 100mg 曲马多 6 剂）。这突出了多模式镇痛作为一种有效的 THA 疼痛控制方法。
