Single-dose premedication enhances multimodal analgesia after knee arthroplasty

Abstract

Background: With the current trend to reduce postoperative opioid use to enhance recovery and address perioperative opioid addiction concerns, the challenge of managing pain after total knee arthroplasty has increased. This study examined the effect of adding a preoperative medication regime to a multimodal postoperative analgesia protocol that included regional anaesthesia.

Materials and methods: Sixty patients undergoing elective first-time unilateral knee arthroplasty received celecoxib 100mg, gabapentin 600mg and dexamethasone 10mg po one hour before skin incision. They were compared to a sequential retrospective cohort of 49 patients. All patients routinely received acetaminophen 650mg po q6h, ibuprofen 400mg po q8h, patient-controlled opioid analgesia and continuous adductor canal blocks postoperatively. Pain scores and opioid consumption were recorded at 4, 8, 12, 24 and 48h.

Results: Pain scores and cumulative opioid use were statistically and clinically significantly reduced at all time points up to 48h.

Conclusions: Combining preoperative oral celecoxib, gabapentin and dexamethasone had a clinically significantly effect in reducing pain scores and opioid use for at least 48h. Most of this effect is probably due to dexamethasone.

Keywords: Anaesthetics: management and care / Anaesthetics: pharmacology / Clinical audit / Enhanced recovery programmes / Evidence-based practice / Patient safety/outcomes / Pharmacology / Post-anaesthetic care / Research: quantitative.