A multimodal intraosseous infusion of morphine and ketorolac decreases early postoperative pain and opioid consumption following total knee arthroplasty.

Autor: McNamara CA; Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA., Laurita J; Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA., Lambert BS; Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA., Sullivan TC; Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA., Clyburn TA; Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA., Incavo SJ; Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA., Park KJ; Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA. Electronic address: KJPark@houstonmethodist.org.
Jazyk: angličtina
Zdroj: The Knee [Knee] 2023 Aug; Vol. 43, pp. 129-135. Date of Electronic Publication: 2023 Jul 01.
DOI: 10.1016/j.knee.2023.06.002
Abstrakt: Background: Multimodal pain management regimens and intraosseous infusion of morphine are two novel techniques that show promise in decreasing postoperative pain and opioid consumption following total knee arthroplasty. However, no study has analyzed the intraosseous infusion of a multimodal pain management regimen in this patient population. The purpose of our investigation was to examine the intraosseous administration of a multimodal pain regimen comprised of morphine and ketorolac during total knee arthroplasty with regard to immediate and 2-week postoperative pain, opioid pain medication intake, and nausea levels.
Methods: In this prospective cohort study with comparisons to a historical control group, 24 patients were prospectively enrolled to receive an intraosseous infusion of morphine and ketorolac dosed according to age-based protocols while undergoing total knee arthroplasty. Immediate and 2-week postoperative Visual Analog Score (VAS) pain scores, opioid pain medication intake, and nausea levels were recorded and compared against a historical control group that received an intraosseous infusion of morphine alone.
Results: During the first four postoperative hours, patients who received the multimodal intraosseous infusion experienced lower VAS pain scores and required less breakthrough intravenous pain medication than those patients in our historical control group. Following this immediate postoperative period, there were no additional differences between groups in terms of pain levels or opioid consumption, and there were no differences in nausea levels between groups at any time.
Conclusions: Our multimodal intraosseous infusion of morphine and ketorolac dosed according to age-based protocols improved immediate postoperative pain levels and reduced opioid consumption in the immediate postoperative period for patients undergoing total knee arthroplasty.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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