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  4. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations.
 
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Titre

PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations.

Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Anaesthesia: Peri-operative medicine, critical care and pain  
Auteur(s)
Anger, M.
Auteure/Auteur
Valovska, T.
Auteure/Auteur
Beloeil, H.
Auteure/Auteur
Lirk, P.
Auteure/Auteur
Joshi, G.P.
Auteure/Auteur
Van de Velde, M.
Auteure/Auteur
Raeder, J.
Auteure/Auteur
Contributrices/contributeurs
Joshi, G.P.
Pogatzki-Zahn, E.
Van de Velde, M.
Kehlet, H.
Bonnet, F.
Rawal, N.
Lavand'homme, P.
Beloeil, H.
Raeder, J.
Sauter, A.
Albrecht, E.
Lirk, P.
Freys, S.
Lobo, D.
Volk, T.
Werner, M.
Bonnet, M.
Groupes de travail
PROSPECT Working Group* and the European Society of Regional Anaesthesia and Pain Therapy
Liens vers les personnes
Albrecht, Eric  
Liens vers les unités
Anesthésiologie  
ISSN
1365-2044
Statut éditorial
Publié
Date de publication
2021-08
Volume
76
Numéro
8
Première page
1082
Dernière page/numéro d’article
1097
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article ; Systematic Review
Publication Status: ppublish
Résumé
The aim of this systematic review was to develop recommendations for the management of postoperative pain after primary elective total hip arthroplasty, updating the previous procedure-specific postoperative pain management (PROSPECT) guidelines published in 2005 and updated in July 2010. Randomised controlled trials and meta-analyses published between July 2010 and December 2019 assessing postoperative pain using analgesic, anaesthetic, surgical or other interventions were identified from MEDLINE, Embase and Cochrane databases. Five hundred and twenty studies were initially identified, of which 108 randomised trials and 21 meta-analyses met the inclusion criteria. Peri-operative interventions that improved postoperative pain include: paracetamol; cyclo-oxygenase-2-selective inhibitors; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone. In addition, peripheral nerve blocks (femoral nerve block; lumbar plexus block; fascia iliaca block), single-shot local infiltration analgesia, intrathecal morphine and epidural analgesia also improved pain. Limited or inconsistent evidence was found for all other approaches evaluated. Surgical and anaesthetic techniques appear to have a minor impact on postoperative pain, and thus their choice should be based on criteria other than pain. In summary, the analgesic regimen for total hip arthroplasty should include pre-operative or intra-operative paracetamol and cyclo-oxygenase-2-selective inhibitors or non-steroidal anti-inflammatory drugs, continued postoperatively with opioids used as rescue analgesics. In addition, intra-operative intravenous dexamethasone 8-10 mg is recommended. Regional analgesic techniques such as fascia iliaca block or local infiltration analgesia are recommended, especially if there are contra-indications to basic analgesics and/or in patients with high expected postoperative pain. Epidural analgesia, femoral nerve block, lumbar plexus block and gabapentinoid administration are not recommended as the adverse effects outweigh the benefits. Although intrathecal morphine 0.1 mg can be used, the PROSPECT group emphasises the risks and side-effects associated with its use and provides evidence that adequate analgesia may be achieved with basic analgesics and regional techniques without intrathecal morphine.
Sujets

Arthroplasty, Replace...

Humans

Pain Management/metho...

Pain, Postoperative/t...

Practice Guidelines a...

analgesia

evidence-based medici...

pain

systematic review

total hip arthroplast...

PID Serval
serval:BIB_CE5DC4082878
DOI
10.1111/anae.15498
PMID
34015859
WOS
000652317900001
Permalien
https://iris.unil.ch/handle/iris/137087
Date de création
2025-05-02T12:42:31.251Z
Date de création dans IRIS
2025-05-20T21:22:57Z
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