PROSPECT provides clinicians with supporting arguments for and against the use of various interventions in postoperative pain based on published evidence and expert opinion. Clinicians must make judgements based upon the clinical circumstances and local regulations. At all times, local prescribing information for the drugs referred to must be consulted.
Grades of recommendation are assigned according to the overall level of evidence on which the recommendations are based, which is determined by the quality and source of evidence: Relationship between quality and source of evidence, levels of evidence and grades of recommendation.
Total hip arthroplasty is a common surgical procedure and is associated with significant postoperative pain. Adequate analgesia with minimal side effects allows for early postoperative mobility, optimal functional recovery and decreased postoperative morbidity (Joshi 2019).
The PROSPECT group has previously published a review on postoperative pain management for total hip arthroplasty in 2005 (Fischer 2005), updated in 2010 (esraeurope.org: total-hip-arthroplasty-2010). The aim of this guideline is to provide clinicians with an updated evidence-based approach to pain management for elective total hip arthroplasty.
The systematic review and recommendations were updated using the recently modified PROSPECT methodology (Joshi 2019), focusing on postoperative pain outcomes while assessing the effects of analgesic interventions in reference to the use of basic analgesics (paracetamol and NSAIDs or COX-2 selective inhibitors) and balancing risks and benefits of analgesic strategies.
COX, cyclooxygenase; IV, intravenous; NSAIDs, non-steroidal anti-inflammatory drugs.
Analgesic interventions that are not recommended * for pain management in patients undergoing total hip arthroplasty.
* It is possible that analgesic approaches not recommended in this review due to limited analgesic efficacy and/or concerns of adverse effects may be appropriate in situations where one or more of the primary recommendations are contra-indicated or otherwise not appropriate to use. Also, it may be appropriate to use additional analgesic interventions beyond the primary recommendations in patients with an anticipated higher than average risk of strong postoperative pain (e.g. chronic opioid use; chronic pain states; or significant psychiatric disorders).
COX, cyclooxygenase; LIA, local infiltration analgesia; TENS, transcutaneous electrical nerve stimulation.