AAOS releases guidelines on pain reduction after orthopedic surgery
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The American Academy of Orthopaedic Surgeons released a clinical practice guideline and appropriate use criteria on the appropriateness of pain alleviation strategies to reduce pain after orthopedic surgery and traumatic injury.
Developed in collaboration with the Major Extremity Trauma Research Consortium, the clinical practice guideline and appropriate use criteria are intended to minimize the use of opioids in the postoperative period for better patient outcomes. According to a press release, these are intended to be used by all qualified and appropriately trained providers and surgeons involved in the alleviation of patient pain and improve function after musculoskeletal injury or orthopedic surgery.
The release noted the clinical practice guideline evaluates 28 therapeutic interventions for pain alleviation, improved function and opioid reduction after musculoskeletal injury or orthopedic surgery to improve care. Highlights of the clinical practice guideline include the following:
- Moderate evidence that there is no difference in patient outcomes between local and regional anesthesia for patients undergoing total knee and hip arthroplasty;
- Strong evidence for the use of continuous regional anesthesia over local anesthesia to reduce pain and opioid use in the first 24 hours after total shoulder arthroplasty;
- Strong evidence for the use of IV ketamine in the perioperative period to reduce opioid use in the first 24 hours after THA and TKA; and
- Strong evidence that acetaminophen should be used to improve patient pain and decrease opioid use.
The release also noted the appropriate use criteria are intended to offer guidance on decision factors for adults with musculoskeletal injuries to the extremity and/or pelvis, with treatment scenarios provided based on recommendations from the clinical practice guidelines. The appropriate use criteria online tool provides algorithms on how to optimally evaluate the condition based on a patient’s various indications, including injury severity/type, pain intensity, magnitude of limitations, pain intensity, magnitude of limitation and degree of energy/polytrauma, according to the release.
“The evidence-based guideline and [appropriate use criteria] AUC tools offer accepted approaches to treatment and/or diagnosis and are not intended to be a fixed protocol,” according to the release. “Patient care and treatment should always be based on a clinician’s independent medical judgement, given the individual patient’s specific clinical circumstances.”
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