Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia.
Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia.
Pain Med. 2022 Aug 31;23(9):1476-1488. doi: 10.1093/pm/pnac052.
Total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgeries are among the most common elective procedures. Moderate to severe postoperative pain during the subacute period (defined here as the period from hospital discharge to 3 months postoperatively) is a predictor of persistent pain 12 months postoperatively. This review aimed to examine the available postdischarge pharmacological interventions, including educational and prescribing strategies, and their effect on reducing pain during the subacute period after TKA or THA.
We searched seven electronic databases from inception to April 22, 2021. Published randomized controlled trials of adults who underwent TKA or THA and received a pharmacological-based intervention commencing within 1 week after hospital discharge and conducted for up to 3 months postoperatively were compared with any treatment. Two reviewers independently extracted data on the primary outcome, pain intensity. This review was registered prospectively on PROSPERO (ID: CRD42021250384).
Four trials involving 660 participants were included. Interventions included changing analgesic prescribing practices upon hospital discharge and education on analgesic use. Providing multimodal non-opioid analgesia in addition to reduced opioid quantity was associated with lower subacute pain (coefficient -0.81; 95% confidence interval -1.33 to -0.29; P = 0.003). Education on analgesic use during multidisciplinary home visits was effective for reducing pain intensity during the subacute period (6.25 ± 10.13 vs 35.67 ± 22.05; P < 0.001) compared with usual care.
Interventions involving the provision of multimodal non-opioid analgesia and education on analgesic use show positive effects on reducing pain intensity during the subacute period after TKA and THA.
全膝关节置换术（TKA）和全髋关节置换术（THA）是最常见的择期手术之一。亚急性期（此处定义为出院后至术后 3 个月）中度至重度术后疼痛是术后 12 个月持续性疼痛的预测因素。本综述旨在检查亚急性期 TKA 或 THA 后可用的出院后药物干预措施，包括教育和处方策略，以及它们在减轻疼痛方面的效果。
我们从建立到 2021 年 4 月 22 日在七个电子数据库中进行了搜索。对接受 TKA 或 THA 并在出院后 1 周内开始使用药物干预措施且持续时间不超过术后 3 个月的成年患者进行了基于药物的随机对照试验，并与任何治疗进行了比较。两位审查员独立提取了主要结局（疼痛强度）的数据。本综述在 PROSPERO（ID：CRD42021250384）上进行了前瞻性注册。
纳入了四项涉及 660 名参与者的试验。干预措施包括改变出院时的镇痛处方实践和使用镇痛药的教育。与减少阿片类药物用量的同时提供多模式非阿片类镇痛与亚急性疼痛降低相关（系数-0.81；95%置信区间-1.33 至-0.29；P=0.003）。在多学科家庭访视中进行的关于镇痛药使用的教育对于减轻亚急性期疼痛强度有效（6.25±10.13 与 35.67±22.05；P<0.001）与常规护理相比。
涉及提供多模式非阿片类镇痛和镇痛药使用教育的干预措施对 TKA 和 THA 后亚急性期疼痛强度的降低具有积极影响。
