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Inicio Revista Española de Cirugía Ortopédica y Traumatología (English Edition) Preventive analgesia in hip or knee arthroplasty: A systematic review
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Vol. 59. Issue 2.
Pages 73-90 (March - April 2015)
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Vol. 59. Issue 2.
Pages 73-90 (March - April 2015)
Review article
DOI: 10.1016/j.recote.2015.01.006
Preventive analgesia in hip or knee arthroplasty: A systematic review
Analgesia preventiva en artroplastia de cadera o rodilla: una revisión sistemática
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J. Díaz-Herediaa,
Corresponding author
jorgedh@gmail.com

Corresponding author.
, E. Lozab, I. Cebreiroa, M.Á. Ruiz Ibana
a Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, Spain
b Instituto de Salud Musculoesquelética, Madrid, Spain
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Tables (4)
Table 1. Search strategy in Medline.
Table 2. Evidence table.
Table 3. Studies excluded after full reading and reasons for exclusion.
Table 4. Main conclusions along with level of evidence and recommendation gradea
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Abstract
Objective

To analyze the efficacy and safety of preventive analgesia in patients undergoing hip or knee arthroplasty due to osteoarthritis.

Methods

A systematic literature review was performed, using a defined a sensitive strategy on Medline, Embase and Cochrane Library up to May 2013. The inclusion criteria were: patients undergoing knee and/or hip arthroplasty, adults with moderate or severe pain (≥4 on a Visual Analog Scale). The intervention, the use (efficacy and safety) of pharmacological treatment (preventive) close to surgery was recorded. Oral, topical and skin patch drugs were included. Systematic reviews, meta-analysis, controlled trials and observational studies were selected.

Results

A total of 36 articles, of moderate quality, were selected. The patients included were representative of those undergoing knee and/or hip arthroplasty in Spain. They had a mean age >50 years, higher number of women, and reporting moderate to severe pain (≥4 on a Visual Analog Scale). Post-surgical pain was mainly evaluated with a Visual Analog Scale. A wide variation was found as regards the drugs used in the preventive protocols, including acetaminophen, classic NSAID, Cox-2, opioids, corticosteroids, antidepressants, analgesics for neuropathic pain, as well as others, such as magnesium, ketamine, nimodipine or clonidine. In general, all of them decreased post-surgical pain without severe adverse events.

Conclusions

The use or one or more pre-surgical analgesics decreases the use of post-surgical drugs, at least for short term pain.

Keywords:
Knee arthroplasty
Hip arthroplasty
Preventive analgesia
Systematic review
Resumen
Objetivo

Analizar la eficacia y la seguridad de la analgesia preventiva en pacientes que son sometidos a artroplastia de cadera o rodilla por artrosis.

Métodos

Se realizó una revisión sistemática: se definió una estrategia de búsqueda bibliográfica sensible en Medline, Embase y Cochrane Library hasta mayo de 2013; se definió la población con los siguientes criterios: pacientes con indicación de artroplastia de cadera y/o rodilla, adultos, dolor moderado a intenso (≥4 en la Escala Visual Analógica), la intervención, el uso (eficacia y seguridad) del tratamiento farmacológico (preventivo) próximo a la cirugía. Se incluyeron formulaciones orales, tópicas y parches. Se incluyeron revisiones sistemáticas, metaanálisis, ensayos clínicos y estudios observacionales.

Resultados

Se incluyeron 36 artículos de calidad moderada. Incluían pacientes representativos de aquellos a los que se les indica una artroplastia de cadera o rodilla en nuestro país, adultos, con una edad media superior a 50 años, ligera mayor proporción de mujeres y que presentan dolor de moderado a grave (≥4 en la Escala Visual Analógica). El dolor posquirúrgico se evaluó sobre todo con la Escala Visual Analógica. Existe mucha variabilidad en cuanto a los fármacos utilizados incluyendo paracetamol, AINE clásicos, AINE selectivos de la Cox-2, opioides, corticoides, antidepresivos, analgésicos para el tratamiento del dolor neuropático y otros como sulfato magnésico, ketamina, nimodipino o clonidina. Todos en general parecen mejorar el dolor posquirúrgico sin presentar acontecimientos adversos graves.

Conclusiones

El uso de uno o varios analgésicos en el preoperatorio disminuye el consumo de analgésicos y el dolor en el posoperatorio, al menos el dolor agudo.

Palabras clave:
Artroplastia de rodilla
Artroplastia de cadera
Analgesia preventiva
Revisión sistemática

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