DOI: https://doi.org/10.15674/0030-59872018311-15
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Multimodal analgesia with anapiron, nonsteriod anti-inflammatory drugs, local infiltrative anesthesia, and pregabalin in case of primary total hip arthroplasty

Stanislav Bondarenko, Volodymyr Filipenko, Mykola Lyzogub, Ahmed Badnaoui, Artur Moysey, Kseniia Lyzogub

Abstract


Objective: to evaluate the effectiveness of anesthesia, side effects and time to activation from the bed patients with hip joint arthritis of the IV stage after total hip arthroplasty using multimodal analgesia with Anapiron, nonsteriod anti-inflammatory drugs, local infiltrative anesthesia, and pregabalin compare to standard opioid analgetics.

Methods: A prospective, randomized comparative study included 100 patients (age 51 to 72 years) with hip arthritis of the IV stage and different etiology after primary total hip arthroplasty. In the study group (50 patients) a protocol of multimodal analgesia was used: pregabalin 150 mg in the evening before surgery, then 150 mg twice a day for 5 days, intraoperative local infiltrative anesthesia of the hip joint region with a mixture (bupivacaine 0.25 % 40 ml, epinephrine 0.3 ml, ketorolac 30 mg, dexamethasone 4 mg); after the surgery — Anapirone 1 g, 6 times for 2 days; parecoxib 20 mg, 2 times during the day, then — dexketoprofen 50 mg in case of pain more than 3 points by VAS. In 50 patients of the control group after the surgery have been using opioid drugs parenterally and dexketoprofen 50 mg/day during 2–3 days. The pain syndrome was assessed according to VAS on days 1, 2 and 3 after the operation, also side effects and time to their-self rising from the bed.

Results: in both groups effective anesthesia was achieved without significant difference in the parameter «pain syndrome». Side effects (nausea, vomiting, and dizziness) in the study group are much less common than in the control group. Patients of the control group rose their-self from the bed one day later than in the study group (p = 0.047).

Conclusions: multimodal analgesia with Anapiron, nonsteriod anti-inflammatory drugs, local infiltrative anesthesia, and pregabalin in case of primary total hip arthroplasty allowed us to obtain effective analgesia, decrease the amount of side effects and promote early activation of patients compare to standard regimes with opioid analgetics.


Keywords


multimodal analgesia; arthroplasty; hip joint

References


Zagra, L. (2017). Advances in hip arthroplasty surgery: what is justified? EFORT Open Reviews, 2(5), 171–178. doi:10.1302/2058-5241.2.170008

Wheeler, M., Oderda, G. M., Ashburn, M. A., & Lipman, A. G. (2002). Adverse events associated with postoperative opioid analgesia: A systematic review. The Journal of Pain, 3(3), 159–180. doi:10.1054/jpai.2002.123652

Parvizi, J., Miller, A. G., & Gandhi, K. (2011). Multimodal pain management after total joint arthroplasty. The Journal of Bone and Joint Surgery American Volume, 93(11), 1075–1084. doi:10.2106/jbjs.j.01095

Maheshwari, A. V., Blum, Y. C., Shekhar, L., Ranawat, A. S., & Ranawat, C. S. (2009). Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clinical Orthopaedics and Related Research, 467(6), 1418–1423. doi:10.1007/s11999-009-0728-7

Yang, L., Du, S., & Sun, Y. (2017). Intravenous acetaminophen as an adjunct to multimodal analgesia after total knee and hip arthroplasty: A systematic review and meta-analysis. International Journal of Surgery, 47, 135–146. doi:10.1016/j.ijsu.2017.09.011

Hansen, T. B. (2017). Fast track in hip arthroplasty. EFORT Open Reviews, 2(5), 179–188. doi:10.1302/2058-5241.2.160060

Lamplot, J. D., Wagner, E. R., Manning, D. W. (2014) Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial. Journal of Arthroplasty, 29(2), 329–34. doi: 10.1016/j.arth.2013.06.005

Golladay, G. J., Balch, K. R., Dalury, D. F., Satpathy, J., & Jiranek, W. A. (2017). Oral multimodal analgesia for total joint arthroplasty. The Journal of Arthroplasty, 32(9), S69–S73. doi:10.1016/j.arth.2017.05.002

Domb, B. G., Gupta, A., Hammarstedt, J. E., Stake, C. E., Sharp, K., & Redmond, J. M. (2014). The effect of liposomal bupivacaine injection during total hip arthroplasty: a controlled cohort study. BMC Musculoskeletal Disorders, 15(1). doi:10.1186/1471-2474-15-310

Kuchálik, J., Granath, B., Ljunggren, A., Magnuson, A., Lundin, A., & Gupta, A. (2014). Postoperative pain relief after total hip arthroplasty. Survey of Anesthesiology, 58(4), 202–203. doi:10.1097/01.sa.0000451345.13173.a6

Gupta, T., Garg, N., Gupta, M. (2014) Local infiltration analgesia following total hip replacement: a review of current literature. Chinese Journal of Traumatology, 17(5), 293–297.

Den Eeden, F. M. (2018). Local infiltration anesthesia in total knee and total hip arthroplasty: a brief review. Journal of Anesthesia & Intensive Care Medicine, 5(3). doi:10.19080/jaicm.2018.05.555662

Sinatra, R. S., Jahr, J. S., Reynolds, L., Groudine, S. B., Royal, M. A., Breitmeyer, J. B., & Viscusi, E. R. (2011). Intravenous acetaminophen for pain after major orthopedic surgery: an expanded analysis. Pain Practice, 12(5), 357–365. doi:10.1111/j.1533-2500.2011.00514.x

Singla, N. K., Hale, M. E., Davis, J. C., Bekker, A., Gimbel, J., Jahr, J., … Viscusi, E. R. (2015). IV Acetaminophen. American Journal of Therapeutics, 22(1), 2–10. doi:10.1097/mjt.0000000000000026

Kelly, J. S., Opsha, Y., Costello, J., Schiller, D., & Hola, E. T. (2014). Opioid Use in Knee Arthroplasty After Receiving Intravenous Acetaminophen. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 34(S1), 22S–26S. doi:10.1002/phar.1518

Smith, H. S. (2009) Potential analgesic mechanisms of acetaminophen. Pain Physician, 12(1), 269–280.

Liang, L., Cai, Y., Li, A., & Ma, C. (2017). The efficiency of intravenous acetaminophen for pain control following total knee and hip arthroplasty. Medicine, 96(46), e8586. doi:10.1097/md.0000000000008586

Malan, T. P., Marsh, G., Hakki, S. I., Grossman, E., Traylor, L., & Hubbard, R. C. (2003). Parecoxib sodium, a parenteral Cyclooxygenase 2 selective inhibitor, improves morphine analgesia and is opioid-sparing following total hip arthroplasty. Anesthesiology, 98(4), 950–956. doi:10.1097/00000542-200304000-00023

Hubbard, R., Naumann, T., Traylor, L., & Dhadda, S. (2003). Parecoxib sodium has opioid-sparing effects in patients undergoing total knee arthroplasty under spinal anaesthesia. British Journal of Anaesthesia, 90(2), 166–172. doi:10.1093/bja/aeg038

Camu, F., Borgeat, A., Heylen, R. J., Viel, E. J., Boye, M. E., & Cheung, R. Y. (2016). Parecoxib, propacetamol, and their combination for analgesia after total hip arthroplasty: a randomized non-inferiority trial. Acta Anaesthesiologica Scandinavica, 61(1), 99–110. doi:10.1111/aas.12841




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