Characterization of patients undergoing total knee arthroplasty in a real-world setting and pain-related medication prescriptions for management of postoperative pain

Analgesic Effect of Pre-Emptive Gabapentin on Knee Surgery: A Systematic Review and Meta-Analysis

We aimed to evaluate the effectiveness of preemptive oral gabapentin on postoperative analgesia after knee surgery. Gabapentin is widely known to reduce postoperative pain scores and opioid requirements following a variety of surgeries. We searched MEDLINE (January 1, 1976 to April 30, 2014), EMBASE (January 1, 1985 to April 30, 2014), the Cochrane Library (January 1, 1987 to April 30, 2014), and KoreaMed (June 1, 1958 to April 30, 2014). A total of 225 patients in 4 studies were included in the study. The overall pooled results from meta-analysis demonstrated that compared with placebo, pre-emptive analgesia could significantly reduce the postoperative pain score [mean difference (MD) −6.29; 95% confidence interval (CI) −10.17 to −2.42; P = 0.001; random-effect model]. The subgroup analyses found that gabapentin significantly reduced the postoperative pain score in patients who underwent general anesthesia (MD, −17.82; 95% CI, −21.82 to −13.81; P = 0.47; fixed-effect model). The subgroup analyses could not clarify the effectiveness of gabapentin on reducing postoperative pain in patients who underwent regional anesthesia (MD, 2.43; 95% CI, −1.14 to 6.00; P = 0.78; fixed-effect model). Pre-emptive gabapentin reduced early postoperative pain scores. However, it was unclear whether gabapentin reduces postoperative pain score in the setting of regional anesthesia or multimodal analgesic regimen.

Anxiety and depression in patients with osteoarthritis: impact and management challenges

Background

Anxiety and depression are common psychological comorbidities that impact the quality of life (QoL) of patients. In this systematic review, we 1) determined the impact of anxiety and depression on outcomes in patients with osteoarthritis (OA) and 2) summarized unique challenges these comorbidities present to current OA management.

Patients and methods

A systematic literature search was performed using the OVID Medline and EMBASE databases until April 2016. Full-text research articles published in English from the year 2000 onward with a sample size of >100 were included in this review. Eligible research articles were reviewed and the following data were extracted: study author(s), year of publication, study design, and key findings.

Results

A total of 38 studies were included in the present review. The present study found that both anxiety and/or depression were highly prevalent among patients with OA. Patients with OA diagnosed with these comorbidities experienced more pain, had frequent hospital visits, took more medication, and reported less optimal outcomes. Management strategies in the form of self-care, telephone support, audio/video education programs, and new pharmacotherapies were reported with favorable results.

Conclusion

Anxiety and depression adversely impact the QoL of patients with OA. Physicians/caregivers are highly recommended to consider these comorbidities in patients with OA. Ultimately, a holistic individualized management approach is necessary to improve patient outcomes.

Cryotherapy on postoperative rehabilitation of joint arthroplasty

PURPOSE

The effectiveness of cryotherapy on joint arthroplasty recovery remains controversial. This systematic review was conducted to assess the effectiveness of cryotherapy in patients after joint arthroplasty.

METHODS

Comprehensive literature searches of several databases including Cochrane Library (2013), MEDLINE (1950-2013), and Embase (1980-2013) were performed. We sought randomised controlled trials that compared the experimental group received any form of cryotherapy with any control group after joint arthroplasty. The main outcomes were postoperative blood loss, adverse events, and pain. Analyses were performed with Revman 5.0. Results were shown as mean differences (MD) and standard deviations or as risk difference and 95 % confidence intervals (CIs).

RESULTS

Ten trials comprised 660 total knee arthroplastys and three trials comprised 122 total hip arthroplastys (THAs) met the inclusion criteria. Blood loss was significantly decreased by cryotherapy (MD = -109.68; 95 % CI -210.92 to -8.44; P = 0.03). Cryotherapy did not increase the risk of adverse effect (n.s.). Cryotherapy decreased pain at the second day of postoperative (MD = -1.32; 95 % CI -2.37 to -0.27; P = 0.0003), but did not decreased pain at the first and third day of postoperative (n.s.).

CONCLUSIONS

Cryotherapy appears effective in these selected patients after joint arthroplasty. The benefits of cryotherapy on blood loss after joint arthroplasty were obvious. However, the subgroup analysis indicated that cryotherapy did not decreased blood loss after THA. Cryotherapy did not increase the risk of adverse effect. Cryotherapy decreased pain at the second day of postoperative, but did not decreased pain at the first and third day of postoperative.

LEVEL OF EVIDENCE

II.