Non-pharmaceutical treatments to relieve pain or reduce opioid analgesic intake and improve quality of life after total hip replacement: a meta analysis


Author: Minying Li1, Weipeng Sun2, Ruoyu Zhou2, Yingjie Huang1, Fanhang Meng3, Lieliang Luo2, Zijian Yan2, Xiaofan Shi1, Feng Huang4, Chun Fan5, Ziwei Jiang4

Affiliation: <sup>1</sup> Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine Guangzhou 510006, Guangdong, China.

<sup>2</sup> First Clinical College, Guangzhou University of Chinese Medicine Guangzhou 510006, Guangdong, China.

<sup>3</sup> Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou 510000, Guangdong, China.

<sup>4</sup> Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou 510405, Guangdong, China.

<sup>5</sup> Guangzhou University of Chinese Medicine Guangzhou 510000, Guangdong, China.
Conference/Journal: Am J Transl Res
Date published: 2022 Oct 15
Other:
 Volume ID: 14   ,  Issue ID: 10   ,  Pages: 6828-6845   ,  Word Count: 257  
    To reduce pain after total hip replacement (THR), researchers are interested in drug-free interventions. However, there is still a lack of consensus on their prevention efficacy. We performed a meta-analysis to evaluate the use of nonpharmaceutical interventions for postoperative pain management after THR. We searched the Cochrane Library, MEDLINE, EMBASE, Web of Science, PEDRO, and ClinicalTrials.gov databases for articles published between and 1991 and 2020. The main outcome measures were postoperative pain, opioid consumption, and quality of life (QoL). In total, 1,942 patients were studied. We found moderate evidence indicating postoperative pain relief measured by the Western Ontario and McMaster Universities Arthritis Index Scale, with mean differences (MDs) of -0.28 (95% confidence interval [CI], -0.49 to -0.07; P=0.01; I2 =0%) within three months, -0.19 (95% CI, -0.40 to 0.02; P=0.07; I2 =0%) between 3-6 months, and -0.13 (95% CI, -0.35 to 0.08; P=0.21; I2 =0%) between 6-12 months. Additionally, we found that acupuncture therapy could reduce opioid analgesic consumption (MD, -0.98; 95% CI, -1.18 to -0.79; fentanyl [mg/h]; P<0.01; I2 =72.2%) and significantly improve pain relief with an MD of 0.90 (95% CI, 0.47 to 1.33; P<0.01; I2 =0%) measured using the visual analog scale. Electrotherapy slightly improved perceived pain with an MD of 0.22 (95% CI, -0.27 to 0.70; P=0.37; I2 =0%). Moreover, moderate evidence has shown that preoperative exercises improve QoL. This meta-analysis suggested that continuous passive motion did not improve pain or QoL. Postoperative exercise was associated with pain relief and improved QoL. Acupuncture therapy after THR has been shown to reduce opioid analgesic consumption.



Keywords: Non-pharmaceutical interventions; meta-analysis; opioid consumption; pain relieve; quality of life; total hip replacement.



PMID: 36398259 PMCID: PMC9641482