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Multimodal Analgesia Cuts Complications Post Arthroplasty

Fewer respiratory, GI issues; reductions also seen in opioid prescriptions and hospital length of stay

WEDNESDAY, March 7, 2018 (HealthDay News) — Use of multimodal analgesia is associated with fewer complications, reduced opioid prescriptions, and reduced hospital length of stay after total hip/knee arthroplasty, according to a study published online March 1 in Anesthesiology.

Stavros G. Memtsoudis, M.D., Ph.D., from the Weill Cornell Medical College in New York City, and colleagues included data from 512,393 total hip arthroplasties and 1,028,069 total knee arthroplasties from the Premier Perspective database (2006 to 2016). The number and type of analgesic modes were examined, and groups were categorized as opioids only, and one, two, or more than two additional modes.

The researchers found that 85.6 percent of patients received multimodal analgesia. Additions of analgesic modes correlated with stepwise positive effects in multivariable models: Compared with the opioids only group, total hip arthroplasty patients receiving more than two modes experienced 19 percent fewer respiratory and gastrointestinal complications (odds ratios, 0.81 and 0.74, respectively). This group also showed up to an 18.5 percent reduction in opioid prescription, and a 12.1 percent decrease in length of stay (all P < 0.05). Similar patterns were seen for total knee arthroplasty. The most effective modalities used seemed to be nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors.

“While the optimal multimodal regimen is still not known, the findings encourage the combined use of multiple modalities in perioperative analgesic protocols,” the authors write.

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