IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0173107.html
   My bibliography  Save this article

Postoperative pain treatment after total knee arthroplasty: A systematic review

Author

Listed:
  • Anders Peder Højer Karlsen
  • Mik Wetterslev
  • Signe Elisa Hansen
  • Morten Sejer Hansen
  • Ole Mathiesen
  • Jørgen B Dahl

Abstract

Introduction: The aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA). Methods: This PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-based analgesic interventions after TKA. Bias was evaluated according to Cochrane methodology. Outcomes were opioid consumption (primary), pain scores at rest and during mobilization, adverse events, and length of stay. Interventions investigated in three or more trials were meta-analysed. Outcomes were evaluated using forest plots, Grading of Recommendations Assessment, Development and Evaluation (GRADE), L’Abbe Plots and trial sequential analysis. Results: The included 113 trials, investigating 37 different analgesic interventions, were characterized by unclear/high risk of bias, low assay sensitivity and considerable differences in pain assessment tools, basic analgesic regimens, and reporting of adverse events. In meta-analyses single and continuous femoral nerve block (FNB), intrathecal morphine, local infiltration analgesia, intraarticular injection of local anaesthetics, non-steroidal anti-inflammatory drugs, and gabapentinoids demonstrated significant analgesic effects. The 24-hour morphine-sparing effects ranged from 4.2 mg (CI: 1.3, 7.2; intraarticular local anaesthetics), to 16.6 mg (CI: 11.2, 22; single FNB). Pain relieving effects at rest at 6 hours ranged from 4 mm (CI: -10, 2; gabapentinoids), to 19 mm (CI: 8, 31; single FNB), and at 24 hours from 3 mm (CI: -2, 8; gabapentinoids), to 16 mm (CI: 8, 23; continuous FNB). GRADE-rated quality of evidence was generally low. Conclusion: A low quality of evidence, small sample sizes and heterogeneity of trial designs prohibit designation of an optimal procedure-specific analgesic regimen after TKA.

Suggested Citation

  • Anders Peder Højer Karlsen & Mik Wetterslev & Signe Elisa Hansen & Morten Sejer Hansen & Ole Mathiesen & Jørgen B Dahl, 2017. "Postoperative pain treatment after total knee arthroplasty: A systematic review," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-53, March.
    • Handle: RePEc:plo:pone00:0173107
    DOI: 10.1371/journal.pone.0173107
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173107
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0173107&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0173107?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Unknown, 2010. "Table of Contents," 2010 Conference: Modern management challenges in the agro-food sector, March 18-19, Pivola, Slovenia 183902, Slovenian Association of Agricultural Economists (DAES).
    2. Ejis, 2010. "Table of Contents," European Journal of Interdisciplinary Studies, Bucharest Economic Academy, issue 02, June.
    3. Ejis, 2010. "Table of Contents," European Journal of Interdisciplinary Studies, Bucharest Economic Academy, issue 01, March.
    4. Unknown, 2005. "Table of Contents," International Food and Agribusiness Management Review, International Food and Agribusiness Management Association, vol. 8(1), pages 1-1.
    5. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    6. Ejis, 2017. "Table of Contents," European Journal of Interdisciplinary Studies, Bucharest Economic Academy, issue 02, June.
    7. Unknown, 2005. "Table of Contents," 2005 Conference: Slovenia in the EU - Challenges for Agriculture, Food Science and Rural Affairs, November 10-11, 2005, Moravske Toplice, Slovenia 183805, Slovenian Association of Agricultural Economists (DAES).
    8. Ejis, 2017. "Table of Contents," European Journal of Interdisciplinary Studies, Bucharest Economic Academy, issue 01, March.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Surjya Prasad Upadhyay & Sudhakar Tellicherry & Sunil Kulkarni & Partha P Saikia & Piyush N mallick & Waleed Elmatite, 2017. "Postoperative Analgesia in Total Knee Arthroplasty (Tka)-The Changing Trends," Biomedical Journal of Scientific & Technical Research, Biomedical Research Network+, LLC, vol. 1(3), pages 713-719, August.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Michelle Tew & Philip Clarke & Karin Thursky & Kim Dalziel, 2019. "Incorporating Future Medical Costs: Impact on Cost-Effectiveness Analysis in Cancer Patients," PharmacoEconomics, Springer, vol. 37(7), pages 931-941, July.
    2. Lars Jonung & Eoin Drea, 2010. "It Can't Happen, It's a Bad Idea, It Won't Last: U.S. Economists on the EMU and the Euro, 1989–2002," Econ Journal Watch, Econ Journal Watch, vol. 7(1), pages 1-4–52, January.
    3. BenYishay, Ariel & Grosjean, Pauline & Vecci, Joe, 2017. "The fish is the friend of matriliny: Reef density and matrilineal inheritance," Journal of Development Economics, Elsevier, vol. 127(C), pages 234-249.
    4. Gutierrez del Arroyo, Jose & Bindewald, Jason & Graham, Scott & Rice, Mason, 2017. "Enabling Bluetooth Low Energy auditing through synchronized tracking of multiple connections," International Journal of Critical Infrastructure Protection, Elsevier, vol. 18(C), pages 58-70.
    5. Nores, Milagros & Bernal, Raquel & Barnett, W. Steven, 2019. "Center-based care for infants and toddlers: The aeioTU randomized trial," Economics of Education Review, Elsevier, vol. 72(C), pages 30-43.
    6. Rao, Smitha, 2020. "A natural disaster and intimate partner violence: Evidence over time," Social Science & Medicine, Elsevier, vol. 247(C).
    7. Xibo Wang & Mingtao Yao & Jiashuo Li & Kexue Zhang & He Zhu & Minsi Zheng, 2017. "China’s Rare Earths Production Forecasting and Sustainable Development Policy Implications," Sustainability, MDPI, vol. 9(6), pages 1-14, June.
    8. Rikki Jones & Cindy Woods & Kim Usher, 2018. "Rates and features of methamphetamine‐related presentations to emergency departments: An integrative literature review," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(13-14), pages 2569-2582, July.
    9. Ikeme, Sionegael & Han, Doo Bong, 2021. "The Impacts of the EU Integration on Food Production in Baltic Countries," 2021 Annual Meeting, August 1-3, Austin, Texas 313989, Agricultural and Applied Economics Association.
    10. Amarzaya Jadambaa & Nicholas Graves & Donna Cross & Rosana Pacella & Hannah J. Thomas & James G. Scott & Qinglu Cheng & David Brain, 2022. "Economic Evaluation of an Intervention Designed to Reduce Bullying in Australian Schools," Applied Health Economics and Health Policy, Springer, vol. 20(1), pages 79-89, January.
    11. Jian Zhang & Xuena Zhang & Hui Wang & Haibin Zhou & Tian Tian & Anshi Wu, 2017. "Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-17, August.
    12. H. Douglas Witte, 2010. "Outliers and the Halloween Effect: Comment on Maberly and Pierce," Econ Journal Watch, Econ Journal Watch, vol. 7(1), pages 91-98, January.
    13. Shaw, Norman, 2014. "The role of the professional association: A grounded theory study of Electronic Medical Records usage in Ontario, Canada," International Journal of Information Management, Elsevier, vol. 34(2), pages 200-209.
    14. Shunli Yao, 2007. "Chinese Foreign Trade Performance and the China-US Trade 1995 – 2004 - A Graphical Analysis Based on China Customs Statistics," Trade Working Papers 22716, East Asian Bureau of Economic Research.
    15. Helen Lee & Sarah Shea Crowne & Melanie Estarziau & Keith Kranker & Charles Michalopoulos & Anne Warren & Tod Mijanovich & Jill H. Filene & Anne Duggan & Virginia Knox, "undated". "The Effects of Home Visiting on Prenatal Health, Birth Outcomes, and Health Care Use in the First Year of Life: Final Implementation and Impact Findings from the Mother and Infant Home Visiting Progra," Mathematica Policy Research Reports a9626a8d90bf4f01811d0c9d7, Mathematica Policy Research.
    16. A. Portansky P. & А. Портанский П., 2017. "О перспективах мегарегиональных торговых соглашений // About the Prospects of Megaregional Trade Agreements," Мир новой экономики // The world of new economy, Финансовый университет при Правительстве Российской Федерации // Financial University under The Governtment оf The Russian Federation, issue 3, pages 47-53.
    17. Syed Afroz Keramat & Khorshed Alam & Jeff Gow & Stuart J H Biddle, 2020. "Gender differences in the longitudinal association between obesity, and disability with workplace absenteeism in the Australian working population," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-14, May.
    18. Kaoru YAMAGUCHI, . "Study on ASIAN Potential of Biofuel Market," Books, Economic Research Institute for ASEAN and East Asia (ERIA), number 2013-rpr-20 edited by Kaoru YAMAGUCHI, January.
    19. Marcella Alsan & Sarah Eichmeyer, 2024. "Experimental Evidence on the Effectiveness of Nonexperts for Improving Vaccine Demand," American Economic Journal: Economic Policy, American Economic Association, vol. 16(1), pages 394-414, February.
    20. Minh Ha-Duong & Ngo To Nhien, 2019. "Renewable Energy Law and Auctions in Vietnam," CIRED Working Papers hal-03088132, HAL.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0173107. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.