title: Multi-modal, pre-emptive analgesia decreases the length of hospital stay following total joint arthroplasty.
abstract: Traditional treatment of pain following total joint arthroplasty involves postoperative oral narcotic medications and intravenous patient-controlled analgesia, both of which can result in significant postoperative morbidity. Multi-modal analgesia involving >or=2 classes of drugs acting on different receptor types may be as effective as single-narcotic/patient-controlled analgesia with fewer analgesic-related side effects. In addition, administering analgesia prior to surgery (pre-emptive) may reduce postoperative pain intensity. The current study was designed to compare the impact of multi-modal pre-emptive analgesia versus patient-controlled analgesia on postoperative nausea, rehabilitation participation, and length of stay following total joint arthroplasty. A retrospective chart review and comparison was performed for patients undergoing total joint arthroplasty who received either postoperatively patient-controlled analgesia or pre-emptive analgesia (scheduled postoperative oxycodone and a COX-2 inhibitor). Length of hospital stay for the pre-emptive group averaged 2.74 vs 3.28 days for patient-controlled analgesia patients. The patient-controlled analgesia group consumed significantly more intravenous morphine (17.7 mg vs 7.2) and experienced a three-fold increase in nausea. In addition, the patient-controlled analgesia group was twice as likely to miss therapy and nearly 2 times more likely to be discharged to an extended care facility. The use of pre-emptive oxycodone and a selective COX-2 inhibitor decreased postoperative narcotic requirements and increased participation in rehabilitation. In addition, patients receiving pre-emptive analgesics had a decreased hospital length of stay and reduced likelihood of discharge to a skilled nursing facility. These data support the continued study and use of pre-emptive multi-modal analgesia paradigms in this population.
authors.affiliation: Division of Orthopedics and Rehabilitation, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9679, USA.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Duellman
authors.forename: Catherine
authors.initials: C
authors.lastname: Gaffigan
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Milbrandt
authors.forename: D Gordon
authors.initials: DG
authors.lastname: Allan
mesh_terms: D000284:Administration, Oral; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D052246:Cyclooxygenase 2 Inhibitors; D010098:Oxycodone