Reducing the pain: A systematic review of postdischarge analgesia following elective orthopedic surgery

Roberts, Matthew, Brodribb, Wendy and Mitchell, Geoffrey (2012) Reducing the pain: A systematic review of postdischarge analgesia following elective orthopedic surgery. Pain Medicine, 13 5: 711-727. doi:10.1111/j.1526-4637.2012.01359.x


Author Roberts, Matthew
Brodribb, Wendy
Mitchell, Geoffrey
Title Reducing the pain: A systematic review of postdischarge analgesia following elective orthopedic surgery
Journal name Pain Medicine   Check publisher's open access policy
ISSN 1526-2375
1526-4637
Publication date 2012-05
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1111/j.1526-4637.2012.01359.x
Volume 13
Issue 5
Start page 711
End page 727
Total pages 17
Place of publication Hoboken, NJ, United States
Publisher Wiley-Blackwell
Collection year 2013
Language eng
Formatted abstract
Objective: This study aimed to determine which analgesic modalities used following discharge have the greatest efficacy in reducing postoperative pain after elective non-axial orthopedic surgery.

Design and Setting: A systematic review was conducted using the databases CENTRAL, MEDLINE, and EMBASE, as well as clinical practice guidelines databases and trial registries. Titles and abstracts were perused by two reviewers for randomized clinical trials in English fulfilling inclusion and exclusion criteria. Quality assessments, including the Oxford Quality Score, selective reporting, and sources of funding, were also performed.

Outcome Measures: Pain intensity/relief, global patient evaluation, and use of rescue analgesia, as well as adverse events and withdrawals. Results. 2,167 articles were retrieved and 23 articles were eligible for inclusion. They investigated analgesic modalities including alternative therapies (5); cyclooxygenase-2 inhibitors (3); nonselective, nonsteroidal anti-inflammatory drugs (NSAIDs) (12); opioids (2); and other pharmaceutical classes (1). Cycooxygenase-2 inhibitors and opioids demonstrated significant efficacy with minimal side effects. Most nonselective NSAIDs were effective analgesics but had a poorer side-effect profile. Alternative therapies demonstrated no significant efficacy.

Conclusions: Opioids and cyclooxygenase-2 inhibitors are effective in providing analgesia in the extended postoperative period following orthopedic surgery with a minimal side-effect profile, while nonselective NSAIDs need to be treated with caution. Homeopathy is not an effective analgesic, while acupuncture has varied evidence and effectiveness. Treatment of postoperative fatigue may also improve analgesia control. This study provides orthopedic surgeons with a basis for evidence-based prescribing of postdischarge analgesia. However, further studies to validate these results against modern reporting standards are needed.
Keyword Postoperative pain
Orthopedic surgery
Analgesia
Primary care
Postdischarge
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Discipline of General Practice Publications
Official 2013 Collection
School of Biomedical Sciences Publications
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 10 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 12 times in Scopus Article | Citations
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