title: Preventive analgesia in hip or knee arthroplasty: a systematic review.
abstract: OBJECTIVE
  To analyze the efficacy and safety of preventive analgesia in patients undergoing hip or knee arthroplasty due to osteoarthritis.
  
  
  METHODS
  A systematic literature review was performed, using a defined a sensitive strategy on Medline, Embase and Cochrane Library up to May 2013. The inclusion criteria were: patients undergoing knee and/or hip arthroplasty, adults with moderate or severe pain (≥4 on a Visual Analog Scale). The intervention, the use (efficacy and safety) of pharmacological treatment (preventive) close to surgery was recorded. Oral, topical and skin patch drugs were included. Systematic reviews, meta-analysis, controlled trials and observational studies were selected.
  
  
  RESULTS
  A total of 36 articles, of moderate quality, were selected. The patients included were representative of those undergoing knee and/or hip arthroplasty in Spain. They had a mean age >50 years, higher number of women, and reporting moderate to severe pain (≥4 on a Visual Analog Scale). Possurgical pain was mainly evaluated with a Visual Analog Scale. A wide variation was found as regards the drugs used in the preventive protocols, including acetaminophen, classic NSAID, Cox-2, opioids, corticosteroids, antidepressants, analgesics for neuropathic pain, as well as others, such as magnesium, ketamine, nimodipine or clonidine. In general, all of them decreased post-surgical pain without severe adverse events.
  
  
  CONCLUSIONS
  The use or one or more pre-surgical analgesics decreases the use of post-surgical drugs, at least for short term pain.
authors.affiliation: Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España. Electronic address: jorgedh@gmail.com.
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
authors.affiliation: Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: I
authors.initials: I
authors.lastname: Cebreiro
authors.affiliation: Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Ruiz Iban
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D015207:Osteoarthritis, Hip / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010149:Postoperative Pain / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: Artroplastia de rodilla. Artroplastia de cadera. Analgesia preventiva. Revisión sistemática.; Knee arthroplasty. Hip arthroplasty. Preventive analgesia. Systematic review