Nonsteroidal Anti-Inflammatory Drugs in Total Joint Arthroplasty
Published by American Association of Hip and Knee Surgeons (AAHKS) · AAOS Clinical Practice Guidelines and Systematic Review Methodology
Summary
AI-generatedThis clinical practice guideline provides evidence-based recommendations on utilizing NSAIDs for postoperative pain management and reducing opioid consumption in primary total joint arthroplasty patients.
Key Takeaways
- 1Oral NSAIDs given preoperatively or early postoperatively reduce pain and opioid consumption in primary TJA.
- 2Selective COX-2 NSAIDs given preoperatively are superior to early postoperative administration for pain control.
- 3Oral 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.
- 4IV ketorolac administered perioperatively reduces pain and opioid use without the need for high doses; 15 mg and 30 mg doses perform equivalently.
- 5Perioperative NSAIDs do not significantly increase the risk of medical complications, but individual patient comorbidities, dosing, and durations must be considered.
Key Recommendations
Guideline Question 1
- 1A
An oral NSAID administered either preoperatively and/or in the early postoperative period reduces pain and opioid consumption following primary TJA.
StrongTreatment - 1B
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.
ModerateTreatment
Guideline Question 2
- 2A
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).
ModerateTreatment - 2B
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).
ConsensusTreatment
Guideline Question 3
- 3A
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.
StrongTreatment - 3B
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.
ModerateTreatment
Guideline Question 4
- 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.
LimitedManagement
Scope & Objectives
Clinical Topic
Nonsteroidal Anti-Inflammatory Drugs in Total Joint Arthroplasty
Objectives
To improve the treatment of orthopaedic surgical patients and reduce practice variation by promoting a multidisciplinary evidenced-base approach on the use of NSAIDs following primary TJA.
Target Patient Population
Patients undergoing primary total joint arthroplasty (TJA)
Target Providers
Patient Criteria & Setting
Therapeutic Area
Postoperative Pain ManagementGuideline Scope
Care Settings
Evidence Grading
System: AAOS Clinical Practice Guidelines and Systematic Review Methodology
Authors & Contributors
Guideline Features
Learning Context
Difficulty
advanced
Learning Paths