Analgesia combination is key to reducing pulmonary complications after hip or knee replacement

  • Ohnuma T & al.
  • Pain Med
  • 26.02.2020

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Gabapentinoids, either alone or with acetaminophen or NSAIDs, are linked to increased risk for postoperative pulmonary complications (PPCs) with total hip arthroplasty (THA) or total knee arthroplasty (TKA).
  • Acetaminophen plus NSAIDs, however, are linked to lower PPC risk and reduced opioid consumption.

Why this matters

  • PPCs are associated with longer hospital stays, higher health care costs, and increased 30-day mortality.

Study design

  • Study of 863,139 patients who underwent elective primary THA or TKA during 2009-2014.
  • Outcomes: PPCs, ICU admission, opioid consumption on the day of surgery or after surgery.  
  • Funding: VA National Center for Patient Safety.

Key results

  • 75.2% of patients received ≥1 of the 3 drugs.
  • Gabapentinoids, alone or with NSAIDs or acetaminophen, were linked to increased risk for PPCs:
    • aOR, 1.35 (95% CI, 1.27-1.44).
  • PPC risk (aORs; 95% CIs) increased with:
    • Acetaminophen+gabapentinoids: 1.16 (1.08-1.26).
    • NSAIDs+gabapentinoids: 1.28 (1.21-1.34).
  • With acetaminophen+NSAIDs, risk (aORs; 95% CIs) decreased for:
    • PPCs: 0.86 (0.83-0.90).
    • ICU admission: 0.66 (0.60-0.71).
    • Daily opioid consumption: −1.4 (95% CI, −1.5 to −1.2) mg.  

Limitations

  • Retrospective study design.
  • Risk of confounding.

Coauthored with Vijay Rathod, PhD.