Electrotherapy and acupuncture linked with decreased, delayed opioid use after TKA

Investigators found electrotherapy and acupuncture after total knee arthroplasty correlated with a decrease in and later use of opioids.

Researchers performed a systematic review and found 5,509 studies of nonpharmacological interventions for postoperative pain following total knee arthroplasty. Of these studies, 39 randomized controlled trials were included in the meta-analysis. Data from the articles were assessed by two reviewers for risk of bias. The main outcomes evaluated were postoperative pain and consumption of opioids and analgesics.

Results showed the interventions most commonly used included continuous passive motion, preoperative exercise, cryotherapy, electrotherapy and acupuncture. Investigators found moderate-certainty evidence that electrotherapy reduced opioid consumption and opioid use was delayed with acupuncture. Low-certainty evidence demonstrated pain relief with acupuncture.

Cryotherapy correlated with reduced opioid use and increased pain relief, according to very low-certainty evidence. Continuous passive motion and preoperative exercise did not improve pain scores or reduce opioid use. The mean difference on the VAS scale and for opioid use at 1 week and 2 weeks for continuous passive motion were –0.05 and 6.58, respectively. The mean difference on the WOMAC scale for preoperative exercise was –0.14. – by Monica Jaramillo

Disclosure: The research was supported by grant R01HS024096 from the Agency for Healthcare Research and Quality.

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Source:

Tedesco D, et al. JAMA Surg. 2017;doi:10.1001/jamasurg.2017.2872.