American Association of Hip and Knee Surgeons (AAHKS)
Nonsteroidal Anti-Inflammatory Drugs in Total Joint Arthroplasty
Ce document comprend 7 recommandations et 27 références.
Contenu en anglais
Synthèse
This clinical practice guideline provides evidence-based recommendations on utilizing NSAIDs for postoperative pain management and reducing opioid consumption in primary total joint arthroplasty patients.
Guidelines developed collaboratively by multiple major orthopedic and anesthesia societies to address common questions related to the efficacy and safety of NSAIDs in primary TJA to reduce practice variation.
Messages clés
Oral NSAIDs given preoperatively or early postoperatively reduce pain and opioid consumption in primary TJA.
Selective COX-2 NSAIDs given preoperatively are superior to early postoperative administration for pain control.
Oral selective COX-2 NSAIDs used after discharge reduce pain and opioid use following total knee arthroplasty and are recommended as part of multimodal regimens for hip arthroplasty.
IV ketorolac administered perioperatively reduces pain and opioid use without the need for high doses; 15 mg and 30 mg doses perform equivalently.
Perioperative NSAIDs do not significantly increase the risk of medical complications, but individual patient comorbidities, dosing, and durations must be considered.
Recommandations
Guideline Question 1
An oral NSAID administered either preoperatively and/or in the early postoperative period reduces pain and opioid consumption following primary TJA.
Patients concernés: patients undergoing primary TJASituation: primary TJA
Administration of an oral selective clyclooxygenase-2 (COX-2) NSAID immediately preoperatively, compared to early postoperative administration, provides improved postoperative pain control and reduced opioid consumption following primary TJA.
Patients concernés: patients undergoing primary TJASituation: primary TJA
Guideline Question 2
Administration of an oral selective COX-2 NSAID after discharge reduces pain and opioid consumption during the six-week period following a primary total knee arthroplasty (TKA).
Patients concernés: patients undergoing primary total knee arthroplasty (TKA)Situation: primary TKA
In the absence of reliable evidence, it is the opinion of the workgroup that oral selective COX-2 NSAIDs may be used after discharge as part of a multimodal pain regimen to reduce postoperative pain and opioid consumption in patients undergoing primary total hip arthroplasty (THA).
Patients concernés: patients undergoing primary total hip arthroplasty (THA)Situation: primary THA
Guideline Question 3
Administration of IV ketorolac preoperatively, intraoperatively, or within 24 hours postoperatively reduces pain and opioid consumption postoperatively (within the first 48 hours) following primary TJA.
Patients concernés: patients undergoing primary TJASituation: primary TJA
Low-dose (15 mg) and high-dose (30 mg) administration of IV ketorolac immediately postoperatively are equivalent at reducing pain and opioid consumption postoperatively (within the first six hours) following primary TJA.
Patients concernés: patients undergoing primary TJASituation: primary TJA
Guideline Question 4
Oral or IV NSAIDs administered preoperatively, intraoperatively, or postoperatively do not appear to increase the risk of medical complications following primary TJA; however, providers should consider patient comorbidities, the type of NSAID administered, dose, and duration of administration.
Patients concernés: patients undergoing primary TJASituation: primary TJA
