An opioid-sparing protocol with intravenous parecoxib can effectively reduce morphine consumption after simultaneous bilateral total knee arthroplasty

Abstract Multimodal pain management protocol effectively relieves pain following simultaneous bilateral total knee arthroplasty (SBTKA) but is associated with administration of large amounts of opioids in the perioperative period. In this prospective, randomized, assessor-blinded, single-surgeon cli...

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Main Authors: Hsuan-Hsiao Ma, Te-Feng Arthur Chou, Hsin-Yi Wang, Shang-Wen Tsai, Cheng-Fong Chen, Po-Kuei Wu, Wei-Ming Chen
Format: Article
Language:English
Published: Nature Publishing Group 2021-04-01
Series:Scientific Reports
Online Access:https://doi.org/10.1038/s41598-021-86826-7
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spelling doaj-4868da81020c473cafc90d0500d88af72021-04-04T11:35:22ZengNature Publishing GroupScientific Reports2045-23222021-04-011111910.1038/s41598-021-86826-7An opioid-sparing protocol with intravenous parecoxib can effectively reduce morphine consumption after simultaneous bilateral total knee arthroplastyHsuan-Hsiao Ma0Te-Feng Arthur Chou1Hsin-Yi Wang2Shang-Wen Tsai3Cheng-Fong Chen4Po-Kuei Wu5Wei-Ming Chen6Department of Orthopaedics and Traumatology, Taipei Veterans General HospitalDepartment of Orthopaedics and Traumatology, Taipei Veterans General HospitalDepartment of Anesthesiology, Taipei Veterans General HospitalDepartment of Orthopaedics and Traumatology, Taipei Veterans General HospitalDepartment of Orthopaedics and Traumatology, Taipei Veterans General HospitalDepartment of Orthopaedics and Traumatology, Taipei Veterans General HospitalDepartment of Orthopaedics and Traumatology, Taipei Veterans General HospitalAbstract Multimodal pain management protocol effectively relieves pain following simultaneous bilateral total knee arthroplasty (SBTKA) but is associated with administration of large amounts of opioids in the perioperative period. In this prospective, randomized, assessor-blinded, single-surgeon clinical trial, the goal was to validate the efficacy of an opioid-sparing protocol for SBTKA with a reduced opioid dose, while achieving similar pain relief with few adverse events. Fifty-six patients who had undergone SBTKA were randomly allocated to receive either an opioid-sparing or opioid-based protocol. The primary outcome parameters were visual analogue scale (VAS) scores at rest, with movement, and cumulative morphine dose, through time. Secondary outcome parameters included drug-related adverse events and range of motion with continuous passive motion device, through time. In the opioid-sparing group, a lower VAS score with movement at postoperative 24 and 72 h was observed compared with the opioid-based group, but the difference did not reach the minimal clinically importance difference. A reduced cumulative morphine dose was noted in the opioid-sparing group at postoperative 24, 48 and 72 h. In conclusion, the opioid-sparing protocol may be used as an alternative modality for pain management following SBTKA. Similar pain relief effects may be achieved utilizing a reduced cumulative opioid dose, with few opioid related adverse events.https://doi.org/10.1038/s41598-021-86826-7
collection DOAJ
language English
format Article
sources DOAJ
author Hsuan-Hsiao Ma
Te-Feng Arthur Chou
Hsin-Yi Wang
Shang-Wen Tsai
Cheng-Fong Chen
Po-Kuei Wu
Wei-Ming Chen
spellingShingle Hsuan-Hsiao Ma
Te-Feng Arthur Chou
Hsin-Yi Wang
Shang-Wen Tsai
Cheng-Fong Chen
Po-Kuei Wu
Wei-Ming Chen
An opioid-sparing protocol with intravenous parecoxib can effectively reduce morphine consumption after simultaneous bilateral total knee arthroplasty
Scientific Reports
author_facet Hsuan-Hsiao Ma
Te-Feng Arthur Chou
Hsin-Yi Wang
Shang-Wen Tsai
Cheng-Fong Chen
Po-Kuei Wu
Wei-Ming Chen
author_sort Hsuan-Hsiao Ma
title An opioid-sparing protocol with intravenous parecoxib can effectively reduce morphine consumption after simultaneous bilateral total knee arthroplasty
title_short An opioid-sparing protocol with intravenous parecoxib can effectively reduce morphine consumption after simultaneous bilateral total knee arthroplasty
title_full An opioid-sparing protocol with intravenous parecoxib can effectively reduce morphine consumption after simultaneous bilateral total knee arthroplasty
title_fullStr An opioid-sparing protocol with intravenous parecoxib can effectively reduce morphine consumption after simultaneous bilateral total knee arthroplasty
title_full_unstemmed An opioid-sparing protocol with intravenous parecoxib can effectively reduce morphine consumption after simultaneous bilateral total knee arthroplasty
title_sort opioid-sparing protocol with intravenous parecoxib can effectively reduce morphine consumption after simultaneous bilateral total knee arthroplasty
publisher Nature Publishing Group
series Scientific Reports
issn 2045-2322
publishDate 2021-04-01
description Abstract Multimodal pain management protocol effectively relieves pain following simultaneous bilateral total knee arthroplasty (SBTKA) but is associated with administration of large amounts of opioids in the perioperative period. In this prospective, randomized, assessor-blinded, single-surgeon clinical trial, the goal was to validate the efficacy of an opioid-sparing protocol for SBTKA with a reduced opioid dose, while achieving similar pain relief with few adverse events. Fifty-six patients who had undergone SBTKA were randomly allocated to receive either an opioid-sparing or opioid-based protocol. The primary outcome parameters were visual analogue scale (VAS) scores at rest, with movement, and cumulative morphine dose, through time. Secondary outcome parameters included drug-related adverse events and range of motion with continuous passive motion device, through time. In the opioid-sparing group, a lower VAS score with movement at postoperative 24 and 72 h was observed compared with the opioid-based group, but the difference did not reach the minimal clinically importance difference. A reduced cumulative morphine dose was noted in the opioid-sparing group at postoperative 24, 48 and 72 h. In conclusion, the opioid-sparing protocol may be used as an alternative modality for pain management following SBTKA. Similar pain relief effects may be achieved utilizing a reduced cumulative opioid dose, with few opioid related adverse events.
url https://doi.org/10.1038/s41598-021-86826-7
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