Fast-Track Orthopedic Procedures: Analgesia to Traditional IVPCA


For a study, researchers sought to see if intravenous patient-controlled analgesia (IVPCA) in a fast-track joint replacement program was linked to more perioperative opioid intake and a longer stay in the hospital. A total of 80 patients, ranging in age from 18 to 85 years old and with a BMI of 18 to 40, who were undergoing elective total knee arthroplasty were included in the study. Patients were given gabapentin, celecoxib, and acetaminophen before surgery. The surgeon gave patients spinal anesthesia with morphine and fentanyl before surgery and periarticular local anesthetic administration. Following surgery, 80 patients were randomly assigned to 1 of 2 groups: IVPCA (group A, n=40) or non-IVPCA (group B, n=40). The primary outcome was the number of opioids consumed 48 hours after surgery and the length of stay in the hospital. Opioid side effects, patient satisfaction, and pain scores were secondary outcomes. There was no significant difference between the two groups regarding 48-hour postoperative opioid use (median 61.3 vs. 87.5, p=.181) or length of hospital stay (median 49.8 vs. 49.5 hours, p=.89). Patient satisfaction (median 5 in both groups), pain scores, and opioid-related adverse effects were unaffected. Within 48 hours of elective total knee arthroplasty surgery, IVPCA was linked to a nonsignificant reduction in opioid intake. Neither group outperformed in terms of length of hospital stay, opioid-related side effects, pain levels, and patient satisfaction.

Source:www.sciencedirect.com/science/article/abs/pii/S1524904222001060



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