title: SECOT-GEDOS consensus on pre-surgical pain management in knee and hip arthrosis.
abstract: OBJECTIVE
  To develop recommendations, based on best evidence and experience, on pain management in patients undertaking total knee or hip replacement.
  
  
  METHODS
  Nominal group methodology was followed. A group of experts was selected (5 orthopedics, 1 anesthesiologist), who defined the scope, users, topics, preliminary recommendations, and 3 systematic reviews: efficacy and safety of pre-surgical analgesia regarding to post-surgical pain, efficacy and safety of pre-emptive analgesia and pre-operative factors of post-operative pain. The level of evidence and grade of recommendation was established using the Oxford Centre for Evidence Based Medicine, and the level of agreement with the Delphi technique (2 rounds). The Delphi was extended to 39 orthopedics and anesthesiologists. The whole document was reviewed by all the experts.
  
  
  RESULTS
  A total of 21 recommendations were produced. They include specific pharmacological treatment, as well as the evaluation and monitoring of patients on this treatment, and post-operative pre-emptive treatment. Agreement above 70% was reached in 19 recommendations.
  
  
  CONCLUSIONS
  In patients undergoing total knee or hip replacement, a proper evaluation, follow-up, pharmacological and non-pharmacological treatment of predictors of poor surgical outcomes should be performed, especially those related to pre-operative pain. This can improve post-operative pain and surgery outcomes.
authors.affiliation: Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España. Electronic address: drmri@hotmail.com.
authors.forename: M A
authors.initials: MA
authors.lastname: Ruiz Ibán
authors.affiliation: Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínic, Barcelona, España.
authors.forename: F
authors.initials: F
authors.lastname: Maculé
authors.affiliation: Servicio de Traumatología y Cirugía Ortopédica, Hospital Parc Taulí, Sabadell, Barcelona, España.
authors.forename: P
authors.initials: P
authors.lastname: Torner
authors.affiliation: Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Gil Garay
authors.affiliation: Servicio de Traumatología y Cirugía Ortopédica, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Oteo-Álvaro
authors.affiliation: Unidad de Dolor, Hospital Virgen de la Macarena, Sevilla, España.
authors.forename: J M
authors.initials: JM
authors.lastname: López Millán
authors.affiliation: Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Díaz Heredia
authors.affiliation: Instituto de Salud Musculoesquelética, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Loza
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003131:Combined Modality Therapy; D003697:Delphi Technique; D006801:Humans; D015207:Osteoarthritis, Hip / Q000188:drug therapy* / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000188:drug therapy* / Q000601:surgery; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods*
chemical_list: D000700:Analgesics
keywords: Arthrosis; Artroplastia; Artrosis; Dolor; Knee and hip replacement; Pain