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Postoperative Multimodal Pain Management and Opioid Consumption in Arthroscopy Clinical Trials: A Systematic Review.

作者信息

Paul Ryan W, Szukics Patrick F, Brutico Joseph, Tjoumakaris Fotios P, Freedman Kevin B

机构信息

Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A.

Rowan University School of Osteopathic Medicine, Department of Orthopaedic Surgery, Stratford, New Jersey, U.S.A.

出版信息

Arthrosc Sports Med Rehabil. 2021 Dec 17;4(2):e721-e746. doi: 10.1016/j.asmr.2021.09.011. eCollection 2022 Apr.


DOI:10.1016/j.asmr.2021.09.011
PMID:35494281
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9042766/
Abstract

PURPOSE: To provide an updated review of multimodal pain management in arthroscopic surgery by evaluating pain and opioid consumption after shoulder, knee, and hip arthroscopy. METHODS: A comprehensive literature search was performed to identify randomized controlled trials (RCTs) investigating multimodal pain management after shoulder, knee, and hip arthroscopy. Articles were identified from January 2011 through December 2020 using various databases. As the primary outcome variables of this study, differences in postoperative pain and opioid consumption volumes were summarized from all reported postoperative time points. RESULTS: 37 shoulder, 28 knee, and 8 hip arthroscopy RCTs were included in the study. The most frequent bias present in the included RCTs was incomplete outcome data (58%), while group allocation concealment was the least frequent bias (15%). Qualitative analysis of rotator cuff repair ( = 12), anterior cruciate ligament reconstruction ( = 11), meniscectomy ( = 5), femoroacetabular impingement ( = 2), oral medications ( = 8), postoperative interventions ( = 10), and nonpharmacological interventions ( = 6) was performed. CONCLUSIONS: Many multimodal pain management protocols offer improved pain control and decreased opioid consumption after arthroscopic surgery. On the basis of the current literature, the evidence supports an interscalene nerve block with a dexamethasone-dexmedetomidine combination for rotator cuff repair, a proximal continuous adductor canal block for anterior cruciate ligament reconstruction, and local infiltration analgesia (e.g., periacetabular injection with 20 mL of .5% bupivacaine) for hip arthroscopy. When evaluating oral medication, the evidence supports 150 mg Pregabalin for shoulder arthroscopy, 400 mg Celecoxib for knee arthroscopy, and 200 mg Celecoxib for hip arthroscopy, all taken preoperatively. There is promising evidence for the use of various nonpharmacological modalities, specifically preoperative opioid education for rotator cuff repair patients; however, more clinical trials that evaluate nonpharmacological interventions should be performed. LEVEL OF EVIDENCE: Level II, systematic review of Level I and II studies.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cda0/9042766/77745b206982/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cda0/9042766/fde24e553d2f/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cda0/9042766/77745b206982/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cda0/9042766/fde24e553d2f/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cda0/9042766/77745b206982/gr2.jpg

相似文献

[1]
Postoperative Multimodal Pain Management and Opioid Consumption in Arthroscopy Clinical Trials: A Systematic Review.

Arthrosc Sports Med Rehabil. 2021-12-17

[2]
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[3]
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[4]
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[5]
Pain Management After Hip Arthroscopy: Systematic Review of Randomized Controlled Trials and Cohort Studies.

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[6]
Adjunct Analgesia Reduces Pain and Opioid Consumption After Hip Arthroscopy: A Systematic Review of Randomized Controlled Trials.

Am J Sports Med. 2020-12

[7]
Comparison of local infiltration analgesia and interscalene block for postoperative pain management in shoulder arthroscopy: a prospective randomized controlled trial.

Turk J Med Sci. 2021-6-28

[8]
Pain Control After Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials With a Network Meta-analysis.

Am J Sports Med. 2021-7

[9]
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Turk J Med Sci. 2020-2-13

[10]
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Am J Sports Med. 2017-6

引用本文的文献

[1]
Opioid Consumption Following Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Orthop J Sports Med. 2025-7-14

[2]
Declining Postoperative 90-Day Opioid Prescriptions From 2010 to 2021 Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Arthrosc Sports Med Rehabil. 2025-1-16

[3]
90-day Return to the Emergency Department Following Shoulder Arthroscopy: Prevalence, Risk Factors, and Reasons.

Arch Bone Jt Surg. 2024

[4]
Postoperative Pain Control After ACL Reconstruction With Semitendinosus Tendon Graft: A Randomized Controlled Trial Comparing Adductor Canal Block to Local Infiltration Analgesia.

Orthop J Sports Med. 2024-11-15

[5]
Preoperative versus postoperative nonsteroidal anti-inflammatory drugs in femoroacetabular impingement patients undergoing hip arthroscopy surgery: analgesic effect, joint function, patients' satisfaction, and quality of life.

Inflammopharmacology. 2024-12

[6]
Comparison of genicular nerve block with adductor canal block for postoperative pain management in patients undergoing arthroscopic knee ligament reconstruction: A randomised controlled trial.

Indian J Anaesth. 2024-5

[7]
[Research progress on early postoperative pain management strategies after arthroscopic anterior cruciate ligament reconstruction].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024-2-15

[8]
Superior Trunk Block Is an Effective Phrenic-Sparing Alternative to Interscalene Block for Shoulder Arthroscopy: A Systematic Review and Meta-Analysis.

Cureus. 2023-11-3

[9]
How Patients Dispose of Unused Prescription Opioids: A Survey of over 300 Postoperative Patients.

Cureus. 2022-8-17

本文引用的文献

[1]
Pain Management Strategies After Anterior Cruciate Ligament Reconstruction: A Systematic Review With Network Meta-analysis.

Arthroscopy. 2021-4

[2]
Pain Control After Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials With a Network Meta-analysis.

Am J Sports Med. 2021-7

[3]
Single-Shot Liposomal Bupivacaine Reduces Postoperative Narcotic Use Following Outpatient Rotator Cuff Repair: A Prospective, Double-Blinded, Randomized Controlled Trial.

J Bone Joint Surg Am. 2020-11-18

[4]
Enhanced Recovery After Surgery Trends in Adult Spine Surgery: A Systematic Review.

Int J Spine Surg. 2020-8

[5]
Can We Eliminate Opioid Medications for Postoperative Pain Control? A Prospective, Surgeon-Blinded, Randomized Controlled Trial in Knee Arthroscopic Surgery.

Am J Sports Med. 2020-8-5

[6]
Adjunct Analgesia Reduces Pain and Opioid Consumption After Hip Arthroscopy: A Systematic Review of Randomized Controlled Trials.

Am J Sports Med. 2020-12

[7]
Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery: A Multicenter Randomized Trial.

Anesthesiology. 2020-4

[8]
Reduction of Postoperative Hip Arthroscopy Pain With an Ultrasound-Guided Fascia Iliaca Block: A Prospective Randomized Controlled Trial.

Am J Sports Med. 2020-1-30

[9]
Comparison of the effects of perineural or intravenous dexamethasone on low volume interscalene brachial plexus block: a randomised equivalence trial.

Br J Anaesth. 2019-10-5

[10]
Fascia Iliaca Blockade With the Addition of Liposomal Bupivacaine Versus Plain Bupivacaine for Perioperative Pain Management During Hip Arthroscopy: A Double-Blinded Prospective Randomized Control Trial.

Arthroscopy. 2019-8-8

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