Study details: Seven studies (n=380) have examined the effect of postoperative conventional NSAIDs compared with placebo on postoperative pain in total hip arthroplasty (Dahl 1995, Fletcher 1995, Fogarty 1995b, Iohom 2002, Laitinen 1992, Segstro 1991, Serpell 1989). One study compared the following conventional NSAIDs postoperatively, when the spinal anaesthesia had worn off: ketorolac 30 mg IV loading dose plus 90 mg IV infusion over 15.5 h, diclofenac 75 mg IV loading dose plus 75 mg IV over 15.5 h, and ketoprofen 100 mg IV loading dose plus 100 mg IV over 15.5 h (Kostamovaara 1998).
Study details: No total hip arthroplasty-specific studies were found within the parameters of the systematic review that compared the analgesic effects of postoperative strong opioids with placebo. The studies found have compared different strong opioids and various postoperative dosing regimens (Fee 1989, Frater 1989, Keita 2003, McCormack 1993, Robinson 1991).
One study compared oral morphine sulphate sustained-release tablet, 20 mg with premedication and every 12 h thereafter for 48 h, with IM morphine 10 mg after regression of the spinal motor block and at 6 h intervals thereafter (Bourke 2000)
Study details: Two studies, one in elective hip or knee arthroplasty and the other in spine fusion surgery, compared the same regimens: post-closure continuous wound infusion using a loading dose of ropivacaine 0.5% 200 mg/40 ml followed by ropivacaine 0.2% 5 ml/h through a catheter for 55 h versus control (continuous IV infusion of morphine 0.5 mg/h plus keterolac 3.6 mg/h for 24 h) administered directly into the surgical area –both groups received saline by the alternative route and rescue IV tramadol plus IM diclofenac was available (n=37, n=37) (Bianconi 2004, Bianconi 2003)