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      Comparison of intravenous and oral acetaminophen for pain control after total knee and hip arthroplasty : A systematic review and meta-analysis

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          Abstract

          Objective:

          To evaluate the efficacy between intravenous and oral acetaminophen as adjunct to multimodal analgesia regimens for pain management after total knee and hip arthroplasties.

          Methods:

          We conduct electronic searches of Medline (1966–2017.09), PubMed (1966–2017.09), Embase (1980–2017.09), ScienceDirect (1985–2017.09), and the Cochrane Library. Only randomized controlled trials (RCTs) are included. The quality assessment is performed according to the Cochrane systematic review method. Fixed/random effect model is adopted according to the heterogeneity tested by I 2 statistic. Meta-analysis is performed using Stata 11.0 software.

          Results:

          Two RCTs are included involving 236 patients. The present meta-analysis demonstrated that there were no significant differences between groups regarding pain scores at 12, 24, or 48 hours. No significant differences were observed in terms of opioid consumption at 12, 24, or 48 hours after arthroplasties.

          Conclusion:

          Intravenous acetaminophen to multimodal analgesia dose not demonstrate a significant benefit in reducing pain and opioid consumption compared oral formulation after total knee arthroplasty and total hip arthroplasty. Higher-quality RCTs are required for further research.

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          Most cited references20

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          Acetaminophen from liver to brain: New insights into drug pharmacological action and toxicity.

          Carolina Ghanem, J Pérez María, José E Manautou … (2016)
          Acetaminophen (APAP) is a well-known analgesic and antipyretic drug. It is considered to be safe when administered within its therapeutic range, but in cases of acute intoxication, hepatotoxicity can occur. APAP overdose is the leading cause of acute liver failure in the northern hemisphere. Historically, studies on APAP toxicity have been focused on liver, with alterations in brain function attributed to secondary effects of acute liver failure. However, in the last decade the pharmacological mechanism of APAP as a cannabinoid system modulator has been documented and some articles have reported "in situ" toxicity by APAP in brain tissue at high doses. Paradoxically, low doses of APAP have been reported to produce the opposite, neuroprotective effects. In this paper we present a comprehensive, up-to-date overview of hepatic toxicity as well as a thorough review of both toxic and beneficial effects of APAP in brain.
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            Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center.

            Y. Blum, L Shekhar, Aditya V. Maheshwari … (2009)
            Improvements in pain management techniques in the last decade have had a major impact on the practice of total hip and knee arthroplasty (THA and TKA). Although there are a number of treatment options for postoperative pain, a gold standard has not been established. However, there appears to be a shift towards multimodal approaches using regional anesthesia to minimize narcotic consumption and to avoid narcotic-related side effects. Over the last 10 years, we have used intravenous patient-controlled analgesia (PCA), femoral nerve block (FNB), and continuous epidural infusions for 24 and 48 hours with and without FNB. Unfortunately, all of these techniques had shortcomings, not the least of which was suboptimal pain control and unwanted side effects. Our practice has currently evolved to using a multimodal protocol that emphasizes local periarticular injections while minimizing the use of parenteral narcotics. Multimodal protocols after THA and TKA have been a substantial advance; they provide better pain control and patient satisfaction, lower overall narcotic consumption, reduce hospital stay, and improve function while minimizing complications. Although no pain protocol is ideal, it is clear that patients should have optimum pain control after TKA and THA for enhanced satisfaction and function. Level V, expert opinion. See the Guidelines for Authors for a complete description of levels of evidence.
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              Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial.

              Joseph Lamplot, Eric R. Wagner, David Manning (2014)
              We analyze the effects of a multimodal analgesic regimen on postoperative pain, function, adverse effects and satisfaction compared to patient-controlled analgesia (PCA). Thirty-six patients undergoing TKA were randomized to receive either (1) periarticular injection before wound closure (30cc 0.5% bupivacaine, 10mg MSO4, 15 mg ketorolac) and multimodal analgesics (oxycodone, tramadol, ketorolac; narcotics as needed) or (2) hydromorphone PCA. Preoperative and postoperative data were collected for VAS pain scores, time to physical therapy milestones, hospital stay length, patient satisfaction, narcotic consumption and medication-related adverse effects. The multimodal group had lower VAS scores, fewer adverse effects, lower narcotic usage, higher satisfaction scores and earlier times to physical therapy milestones. Multimodal pain management protocol decreases narcotic usage, improves pain scores, increases satisfaction and enhances early recovery.
              Article 0 comments Cited 64 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: February 2018
                Publication date (Electronic): 09 February 2018
                Volume: 97
                Issue: 6
                Electronic Location Identifier: e9751
                Affiliations
                [a ]Department of Anesthesiology, Qingdao Municipal Hospital
                [b ]Department of Lab, Center for Disease Control and Prevention of Shibei District of Qingdao
                [c ]Department of Pulmonary Medicine, Qingdao Municipal Hospital, Qingdao, China.
                Author notes
                [∗ ]Correspondence: Wei Han, Department of Pulmonary Medicine, Qingdao Municipal Hospital, Qingdao 266011, China (e-mail: 3591939980@ 123456qq.com ).
                Article
                Publisher ID: MD-D-17-05699 Accession ID: 09751
                DOI: 10.1097/MD.0000000000009751
                PMC ID: 5944691
                PubMed ID: 29419667
                SO-VID: 9f9d04bb-8f7b-434b-a07a-7dbe0767eeb1
                Copyright © Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                Date received : 12 September 2017
                Date revision received : 24 November 2017
                Date accepted : 9 January 2018
                Categories
                Subject: 7100
                Subject: Research Article
                Subject: Systematic Review and Meta-Analysis
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: acetaminophen,meta-analysis,pain control,total hip arthroplasty,total knee arthroplasty
                Data availability:
                Keywords: acetaminophen, meta-analysis, pain control, total hip arthroplasty, total knee arthroplasty

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