Non-Opioid Analgesics for Postoperative Pain Management Following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
BACKGROUND: Hip and knee arthroplasty are a fundamental part of modern orthopaedic practice. These procedures often require extensive postoperative analgesia, including opiate painkillers that are frequently associated with adverse side effects and risk of abuse. This review, therefore, investigated how postoperative administration of nonopioid coanalgesics (e.g., parecoxib, pregabalin) can affect postoperative pain scores and opioid use. METHODS: A systematic search of OVID, Embase, Medline, and PubMed was conducted, and studies were filtered to trials of patients undergoing arthroplasty who received nonopioid analgesia. Several meta-analyses were conducted to investigate the effects of various medications and classes at multiple postoperative time points on pain scores and opioid use. Standardized mean differences were conducted for analyses involving more than one measure of pain. There were 28 analyses included in the final review. RESULTS: On average, nonsteroidal anti-inflammatory drugs (NSAIDs) and gabapentinoids reduced between 9.30 and 10.89 mg, respectively of intravenous morphine in a 24-hour period. Reductions were also observed at various time points for NSAIDs, gabapentinoids, parecoxib, and pregabalin. Nonopioid coanalgesia improved pain at rest for various time points, including NSAIDs at postoperative day (POD) 1 and PODs 3 and 5. Parecoxib and corticosteroids were protective at POD 3. Pain during movement was significantly reduced by NSAIDs at 6 hours, POD 1, 2, and 3, with parecoxib demonstrating similar benefits at POD 1 and POD 2 to 3. CONCLUSIONS: This review found that postoperative administration of nonopioid coanalgesia may alleviate the need for opioids and have modest protective effects on postoperative pain. The effects of these analgesics, however, may be clinically nonmeaningful for reducing pain. These results may further implicate a need to implement nonopioid coanalgesia in postoperative patient care. Future research may include an updated investigation of this research question as more medication granular research becomes available.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.019 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.029 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".