Pain management after total hip arthroplasty: comparative study of analgesic efficacy and tolerability between oral tramadol/dexketoprofen and injectable paracetamol + tramadol.

IF 1.3 4区 医学 Q3 ORTHOPEDICS
HIP International Pub Date : 2024-05-01 Epub Date: 2024-01-10 DOI:10.1177/11207000231219797
George A Macheras, Dimitrios Tzefronis, Chrysoula Argyrou, Elena Nikolakopoulou, Alejandro Gálvez Miravete, Thefilos S Karachalios
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引用次数: 0

Abstract

Background: Multimodal analgesia for total hip arthroplasty (THA) is increasingly employed to reduce early postoperative pain and promote fast patient discharge. The aim of this study was to compare the efficacy and tolerability of tramadol/dexketoprofen (TRAM/DKP, Group A) versus paracetamol + tramadol (PARA+TRAM, Group B) in patients undergoing THA using minimally invasive direct anterior approach (DAA).

Methods: A single-centre, randomised, single-blind, parallel, interventional study conducted in 323 patients undergoing primary THA with DAA was performed. Group A consisted of 188 patients and Group B of 135. The primary endpoints were the change from baseline (measured 2 hours postoperatively) in pain intensity (PI) during the treatment period (48 hours), assessed by visual analogue scale (VAS) at pre-specified postoperative time-points (2, 8, 24, 48 hours) and the total rescue medication (RM) use during the first 24 hours postoperatively.

Results: As early as 2 hours after baseline, Group A showed a greater PI reduction from baseline compared to Group B (-26.24% vs. -6.87%; p< 0.001). A lower mean PI (VAS) score was consistently found over the entire observation period following treatment with TRAM/DKP than with PARA+TRAM as well as more than 2-fold higher proportion of responders at the end of treatment period. More patients in Group B required RM in comparison to those in Group A (15.6% vs. 3.7%, p< 0.001). Both treatments were well tolerated.

Conclusions: After THA, oral TRAM/DKP provides faster and greater pain relief when compared to intravenous PARA+TRAM with limited consumption of RM and favourable tolerability profile. Our study expands the use of TRAM/DKP in the setting of major orthopaedic surgeries.

Clinical trial registration: clinicaltrials.gov (NCT04178109).

全髋关节置换术后疼痛治疗:口服曲马多/右酮洛芬与注射用扑热息痛+曲马多镇痛效果和耐受性比较研究。
背景:全髋关节置换术(THA)越来越多地采用多模式镇痛,以减轻术后早期疼痛,促进患者快速出院。本研究旨在比较曲马多/右酮洛芬(TRAM/DKP,A 组)与扑热息痛+曲马多(PARA+TRAM,B 组)在采用微创直接前路(DAA)进行全髋关节置换术的患者中的疗效和耐受性:对 323 名接受 DAA 初级 THA 手术的患者进行了单中心、随机、单盲、平行、干预性研究。A组有188名患者,B组有135名患者。主要终点是治疗期间(48小时)疼痛强度(PI)与基线(术后2小时测量)的变化,在预先规定的术后时间点(2、8、24、48小时)用视觉模拟量表(VAS)进行评估,以及术后24小时内抢救药物(RM)的总用量:与 B 组相比,A 组在基线后 2 小时内的 PI 降低幅度更大(-26.24% 对 -6.87%;P 0.001)。在整个观察期内,TRAM/DKP 治疗后的 PI(VAS)平均得分始终低于 PARA+TRAM 治疗,治疗结束时的应答者比例也比 PARA+TRAM 高出 2 倍多。与 A 组相比,B 组需要 RM 的患者更多(15.6% 对 3.7%,P 0.001)。两种治疗方法的耐受性都很好:结论:与静脉注射 PARA+TRAM 相比,口服 TRAM/DKP 可在 THA 术后更快、更大程度地缓解疼痛,且 RM 用量有限,耐受性良好。临床试验注册:clinicaltrials.gov (NCT04178109)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
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